If your employer-sponsored long-term disability (LTD) claim was denied, don’t give up. Due to the expense and complex nature of LTD claims, insurance companies tend to deny claims for a seemingly endless number of reasons, some legitimate and some not. An experienced Birmingham AL long term disability lawyer can help you navigate the claims and appeals process and make sure you avoid costly mistakes.
At Petro Accident & Injury Attorneys, we assist disabled individuals with their complex LTD and other ERISA claims. Contact us today to learn more about hands-on approach to disability insurance law.
The Employee Retirement Income Security Act of 1974, or ERISA, governs most employer-sponsored fringe benefits, including long-term disability plans. If your employer paid for part or all of your disability insurance coverage, this federal law covers your claim — and you must carefully follow its rules and procedures. A single mistake, such as filing your lawsuit too soon or in state court, can seriously delay your claim and lead to lost benefits and compensation.
LTD claims are very complex. Most successful disability insurance claims require a detailed medical, vocational, and legal analysis that involves a review of your medical records, physical and mental capabilities, disability insurance plan documents, work history and education, and federal laws and case law that may impact your claim.
While every claim is unique, there are some common reasons that lead to a denial:
Many disability claimants don’t realize that they should provide detailed information about their medical conditions, work restrictions, and abilities. Unfortunately, the insurance company’s adjuster probably isn’t going to fill in those gaps. Sometimes, you’ll need to collect doctor and hospital records, diagnostic reports, statements from your physicians, and off-work slips.
Different LTD policies define disability differently. Your Alabama long term disability lawyer will look carefully at your policy’s requirements and how they apply to your unique circumstances.
For example, some policies set strict waiting periods before you can qualify for benefits. Others list a wide variety of medical conditions and circumstances that it refuses to cover. Your attorney will also determine whether you need to be disabled from your own occupation or any job.
ERISA and LTD claims have many filing deadline and strict procedures. If you miss one of these steps, and file your lawsuit too late or too early, you could lose your right to benefits. Some of these deadlines are very short. For example, many LTD plans only give you 180 days to file your initial, administrative appeal. If you’re unsure how to proceed with your claim, you should consult with a long term disability lawyer as quickly as possible.
Disability insurance adjusters are skeptical of claims and are always on the lookout for inconsistencies. If your medical records, forms, or other information provide varying descriptions of your disability, the insurance company may think that you’re exaggerating your symptoms. They may even pay a private investigator to track you in person and online.
While insurance adjusters have a fairly good understanding of common medical conditions like arthritis, they aren’t medical experts. If you have a relatively rare condition, or one like multiple sclerosis (MS) or rheumatoid arthritis (RA) that can wax and wane, they may have a hard time understanding your circumstances. In these cases, it’s always a good idea to consult with an experienced long term disability lawyer who can educate the company (or a judge) about your diagnoses and struggles.
While most insurance adjusters do their best to treat disabled claimants fairly and with respect, some are not as scrupulous. Sometimes, these less-than-honest adjusters intentionally deny or delay claims that meet the LTD plan’s requirements. Other times, they fail to properly investigate the claim and deny the claim before they look at the evidence. Or, they harass and intimidate the claimant. If there is evidence of bad faith on the insurance company’s part, you may have additional claims against it.
As we mentioned above, you must follow a very strict claim process in an LTD case. This typically involves the following:
Each of these steps has its own procedures, filing deadlines, and evidentiary rules. One mistake could be severely detrimental to your claim.
For example, once your LTD claim reaches the federal courts, you typically cannot provide any new evidence, no matter how important it is to your case. Instead, the judge can only review the evidence that was available to the insurance company. For this reason, it’s essential that you carefully review the insurance company’s record before you complete your initial appeal. You must also submit any missing evidence or information that supports your claim.
The thought of wading through thousands of pages of records, while dealing with your doctor’s appointments, “bad days,” and your family’s needs, may sound impossible. That’s why so many people work with a long-term disability lawyer at Petro Accident and Injury Attorneys — they get peace of mind, honest advice, and sophisticated strategies aimed at getting them the benefits they deserve.