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When the unexpected happens and an injury or illness hinders your ability to continue working, it may be that your disability insurance policy represents your best chance to remain financially stable. However, it is all too common for carriers of such policies to raise unfair roadblocks or issue unjust denials, preventing you from obtaining the benefits to which you are entitled.
If you are among those who have received this type of treatment from an insurance company intent on shirking its duty to you as a policyholder, it is wise to enlist the aid of a long term disability lawyer with the knowledge and experience needed to successfully assert your rights.
Denial of benefits under any insurance policy can be a frustrating event, but in the case of those suffering from a serious disability that renders them unable to work for an extended period, it can be financially catastrophic. A sudden and potentially ongoing incapacity preventing gainful employment has the potential to place entire families in real jeopardy, and it is therefore critical to ensure that claims made under disability insurance policies are paid as agreed.
One of the first questions a long term disability practitioner will have is whether the applicable policy is one obtained through an employer or purchased independently and directly through a carrier or an agent. The answer makes a significant difference in how a given case will be handled and will likely proceed.
Individuals whose long term disability insurance was obtained under an employer-sponsored program should know that their plan is likely going to be treated as an employee benefit that falls under the umbrella of the Employee Retirement Income Security Act of 1974 (ERISA), rather than a traditional contract between policyholder and carrier. Because of this categorization, a case of this type will need to proceed under a specific set of rules and regulations different from those that apply to other types of plans.
Obtaining benefits under an ERISA plan of this type can be a complicated endeavor. Insurance carriers often implement onerous documentation and procedural hurdles which can make approvals difficult to win. In addition, it is extremely difficult to overturn a denial under such a plan once it has been issued, as carriers are only required to provide modest justification for their decision. Even seemingly minor errors made during the claims process can permanently derail disability benefits under a policy of this type.
Cases involving benefit denials under ERISA long term disability insurance plans have strict requirements when it comes to the appeals process, and it is therefore essential for claimants who are depending on financial assistance in their time of need to have an advocate with a firm grasp of those rules and how to maximize the chances of approval at the outset.
Prospective disability insurance claimants must understand that carriers often make it their practice to find any possible way to avoid paying benefits under a policy. It is in their interest to save money wherever feasible, and that is why they may do things such as:
An experienced long term disability attorney can help guide individuals through the initial claims process, hopefully preventing the need for an eventual appeal. Reviewing policy documents, making note of key deadlines, assessing medical records and building the strongest possible claim for benefits are among the most important tasks with which a seasoned disability lawyer can help.
Because it is often the case that even the most conscientiously assembled benefits claims can result in a denial, it may be necessary to pursue an appeal and perhaps even formal litigation. The process for seeking review of a denial under an ERISA long term disability plan is known for being arduous and, arguably, stacked against the claimant. Therefore, it is unwise for a policyholder to attempt to go it alone. Rather, securing the guidance and counsel of attorneys with a real track record of success in such appeals can make the difference between defeat and financial peace of mind.
The aftermath of a disabling injury or diagnosis of a serious illness is a time fraught with confusion, uncertainty and for many, true panic. To maximize your chances of receiving the financial benefits to which you are entitled or to aggressively pursue an appeal of a prior denial, we invite you to contact a long term disability lawyer with Young, Marr and Associates at 1-609-557-3081 for a free evaluation of your claim.