When workers are prevented from working due to injury or illness, long term disability (LTD) insurance can be what protects them from serious financial problems. Monthly payments from LTD insurance can make a very uncertain financial situation much more manageable, and people may have to rely on these payments for quite a while: months or even years. Receiving a long term disability insurance denial from Principal Financial Group or other insurance company can feel discouraging, or like it may be the end of the road. But don’t despair! There is still hope. There is a process of administrative appeals and litigation in place to make sure that those who are eligible for disability insurance actually get the benefits they’re owed.

Principal Financial disability claims, along with claims through other insurers, are often denied for any number of reasons, not all of which are justified or legal. It may be due to an error on the claimant’s part, such as missing or inaccurate information. Either way, the claimant who has been denied a disability claim has the right to appeal.

What Is Principal Financial Disability?

Investopedia defines disability insurance as an insurance policy that covers the insured when he or she is unable to work due to a long-term illness or injury. Also known as income protection or long-term disability (LTD), this insurance provides a monthly income to help meet everyday living expenses. Generally, this monthly benefit is equal to approximately 60 percent of the insured’s preinjury income.

Who Evaluates an LTD Claim?

Principal Financial disability insurance is subject to the federal Employee Retirement Income Security Act (ERISA). Under this law, applications are reviewed by claims administrators who are usually employed by the insurer. Often, these people simply deny claims as a matter of course, even when there is clear proof of a disability.

Why Are Claims Denied?

The most common and legitimate reason for denial of a claim at Principal Financial Group and other insurance companies is fairly simple: the lack of medical documentation. Unless the claimant is receiving medical treatment or therapy (physical or psychological), chances are good that the application for benefits will be denied. Any treatments, therapy and/or tests should be thoroughly documented.

Sometimes, the insurer has not received all the claimant’s medical records. One way to ascertain this is to simply ask the insurer for a list of all medical records that have been requested as well as what has been received and what has not. If some records have not been received, it may fall to the insured to make sure the appropriate records get to the right people.

There are several common reasons why a long term disability claim may have been denied, including the following:

• Not meeting the definition of “disabled” under the terms of the policy
• Having an excluded or preexisting condition
• Missing relevant medical records
• Insufficient evidence of the disability
• Self-reported symptoms (rather than hard medical records)
• The insurance company’s doctors disagree with your physician
• Being caught doing things your disability would prevent you from doing

Insurance companies are well within their rights to deny certain claims. However, this does not mean that a claim denial is right. Claim denials are far from the be-all and end-all; indeed, it is quite common for people to start receiving their proper disability insurance benefits after at least one round of administrative appeals.

Principal Financial Group Disability Denial

Based on reviews posted at USInsuranceAgents.com, many consumers have reported difficulties in dealing with Principle Financial Group. 90 percent of those who left comments gave Principal Financial Group very poor reviews in the way they handled claims, with an average rating of 1.5 out of 5.

Can Insurance Company Forms Be Given to the Treating Physician?

They can, but to rely on these alone is not advisable. Often, these company forms are designed in such a way as to elicit responses that will justify a denial of the claim. It is better to obtain a detailed letter from the physician explaining how the insured’s disability limits their ability to work.

How Does an Insurer Define Disability?

Such information can be found in Principal Financial disability insurance policy’s declarations, or “dec sheet.” The term “disability” generally falls under one of two categories: “own occupation” or “any occupation.” Under the former, the insured is considered disabled if they can no longer perform the duties of their regular job. With the latter, disability means the insured is unable to engage in any sort of regular employment.

What Are Exclusions?

This information is also included in the declaration sheet. Exclusions generally include preexisting conditions and medical issues related to substance abuse. Some conditions like depression or chronic fatigue syndrome may be subject to time limits (usually two years).

Should I File a LTD Claim Appeal?

If you are faced with a Principal Financial disability denial or are dealing with another long term disability (LTD) insurer, there are steps you can take to appeal the decision.

Every LTD policy has at least one administrative appeal level available. Many of these policies have two, and it is quite common for people with legitimate disability claims to have to go through this process before receiving their benefits, rather than being granted benefits immediately upon first filing their claim.

It is in fact necessary to go through the entire appeals process before filing a legal claim against the company. This includes gathering all necessary documentation and records, which will be the basis of your lawsuit if or when your appeal is denied.

Keep in mind that no two disability claims are alike; what follows is an overview of the documents that are absolutely necessary to have on hand if you appeal or file a subsequent lawsuit.

My Claim Was Denied. What Should I Do First?

Before starting your appeal, contact your insurer and request a copy of your claim file and the policy itself (also known as the “declarations,” or “dec sheet”). This should include all the information that was used as a basis for their denial, including:

• medical records that were reviewed
• internal communications
• outside medical opinions
• surveillance video

It is important to thoroughly read your denial letter and glean a real understanding of exactly why your claim was denied. That way, you’ll be able to effectively gather and prepare the evidence you will need for the filing of your insurance appeal.

Because appeals are with the same company that denied you the first time, the process may feel quite bleak. However, your appeal is required by law to be evaluated by a different claim unit entirely.

What Additional Evidence Do I Need?

A Principal Financial disability denial or similar action by other insurer is unlikely to be based on their conclusions about whether or not you are physically able to engage in your usual employment. You will need written explanations and support from your treating physicians. This means your primary care doctor along with any and all specialists that are involved in the care of your illness or injury. This is a case of “the more, the better”; you should solicit letters from physical therapists, chiropractors, cardiologists, neurologists and even mental health professionals – any health care provider that has examined and/or worked on your case.

Their letters should explain how your illness or injury has impacted your life and limited your activities. The more of this kind of evidence you can gather, the stronger your claim will be.

This stage is particularly important because you are allowed to add in this new evidence that wasn’t there before. However, after all levels of administrative appeals are exhausted, you will no longer be able to add more evidence, so it is essential that you are as thorough as possible during this process.

Who Else Can Vouch For Me?

Your former employer is also uniquely qualified to testify on your behalf when contesting a Principal Financial disability denial. Get a copy of your personnel file; this can be very effective if you have a history of positive reviews up until you were injured or contracted your illness, as this will clearly demonstrate how your condition has impacted your ability to work.

You can also get written testimony from friends, family members and former co-workers who have seen first-hand the impact of your condition.

I’ve Applied for State and Federal Benefits. Will These Impact my Appeal?

If you have successfully applied for and are receiving benefits from a state or federal program such as Workers Comp or SSD, that can be a powerful factor in proving your disability claim.

What to Know About Filing an Appeal

It is important to meet all deadlines if an initial Personal Income Disability has been denied. Under ERISA, a claimant has 180 days to file an appeal. Having an experienced disability lawyer can be invaluable when it comes to ensuring the administrative record has sufficient evidence to support the claim. Keep in mind that any evidence to be considered by a federal court must also have been submitted to the insurer; otherwise, it will not be admissible.

Finding a Disability Appeals Lawyer

You should only turn to litigation over your Principal Financial disability after you have already exhausted the available levels of administrative appeal. It may help to have an experienced disability appeals lawyer at your side to help you put your appeal letter together, gather the necessary evidence, and figure out what experts in the area might be able to help your case. If you choose to pursue litigation, an experienced disability appeals lawyer will also be able to help you navigate the complexities of litigation and maximize your potential compensation.

Get Help With Your Long Term Disability Insurance Appeal

If an insurance company denied your long-term disability insurance claim within the past 180 days, a knowledgeable insurance attorney can help you appeal.

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