Tamara Burns  |  September 1, 2015

Category: Consumer News

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Disability insuranceFiling a disability insurance claim can be a long and complicated process. As if the underlying disability is not difficult enough, the stress of the whole procedure can be simply exhausting.

Disability insurance exists to help workers recover lost wages when they become unable to work. However, sometimes insurers deny disability benefits, leaving disabled workers feeling angry, lost, and frustrated.

If you have filed a claim to receive disability insurance benefits but were denied, you may have a legal claim. Before considering legal action against the disability insurance company, you must ensure that you have exhausted all other channels before taking this major step.

Review Your Disability Claim Denial

If the insurance company denies the initial claim for insurance benefits, it is important to understand the reasons. Some of the most common reasons for denying disability insurance benefits include:

  • Certain illnesses or injuries are not covered by the disability insurance policy and claimants are ineligible for benefits.
  • Time limits for filing the claim were not followed, and deadlines were missed.
  • The insurance company may not agree with the statement of disability and related information provided by the doctor.

You may not be able to do anything about the missed deadlines, but there may be ways to provide further information if your claim was denied for other reasons. Most times this information will be provided during the appeal process.

What Happens Next

If your insurance is through employee-sponsored disability coverage as part of your benefits, your next step under federal law is to pursue the claim through a formal appeal process through the company. An appeal process must be undertaken and the claimant may not proceed with a lawsuit until completing the appeal process.

If you purchased your own private disability insurance through a broker, you must follow the terms of your policy. Some companies allow individuals to file a lawsuit as the next step, while other companies require that their customers go through an administrative appeals process.

Navigating the Administrative Appeal

The appeal process is a very important step for any claimant. Careful documentation and strictly adhering to guidelines and deadlines are crucial. Not following guidelines exactly as presented and missing important deadlines can create an automatic denial of the appeal.

Successfully navigating the appeal process can lead to a successful appeal, and in that case, the disability claim will be approved and payment will commence.

On the other hand, the process can also lead to an unsuccessful appeal. Unsuccessful appeals, while disappointing, are not the end of the road. It is very important for claimants to follow appeals procedures completely and accurately to be sure all avenues were exhausted before moving forward with litigation. Following the rules and using the proper channels are very important to make a successful case.

Filing a Lawsuit After a Failed Appeal

Having private vs. employer-sponsored disability insurance often dictates how a lawsuit may be filed. Under private insurance, claimants may usually file a standard lawsuit, where the plaintiff will have a trial, presenting evidence and calling witnesses. Employer-sponsored insurance lawsuits are controlled by federal law.

During a lawsuit, a judge will often give the most consideration to the information already collected from the claim and appeals process. The detailed information and documentation from the claimant, including reports from the doctor, supplemental information from the employer, and any other relevant information that was presented in the claim and during the appeals process, is of utmost importance.

Moving Forward After a Lawsuit or Appeal

Once disability benefits are granted through an appeal or through a lawsuit, it is important to continue to keep excellent documentation of your condition and situation. Many insurance companies will only pay disability benefits for a limited amount of time, around two years, before they are stopped. At that time, claimants will likely need to show that they cannot perform any job, not just the original job they held, in order to receive continuing benefits.

Disability Insurance Lawsuit Consultation

If you have been denied insurance for disability benefits and you want to know your legal options, a personal consultation with a lawyer is a beneficial first step. Contact an experienced disability attorney today to review your case at no cost or obligation.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

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Get Help – It’s Free

Get Help With Your Long Term Disability Insurance Appeal

If you were denied a disability claim or had your disability benefits terminated without reason, you may be able to take legal action. See if you qualify by filling out the short form below.

An attorney will contact you if you qualify to discuss the details of your potential case at no charge to you.

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