The Law Offices of Sadaka Associates is dedicated and persistent in providing this support to clients. They have represented people in long term disability claims and have helped their clients get rewarded with the compensation to which they are entitled. Learn more about Long Term Disability Insurance Denials.
Long-term disability insurance is intended to help support you if you’re sick or injured and cannot work. Sadly, what should be an uncomplicated process is anything but simple. Despite paying premiums for years, your insurance company may have unfairly denied your legitimate disability insurance claim, leaving you without a steady income.
These policies are governed by federal law under ERISA, the Employee Retirement Income Security Act. Consumers buy disability insurance to protect themselves in the event they cannot work because of a physical or mental ailment. So when a consumer files a disability claim that’s then denied by their insurance company, instead of helping the individual, it ends up making their life that much more challenging.
Many people think that long-term disability only covers injuries that happen on the job. While on the job injuries may be covered, more than 95% of long-term disability claims are estimated to be non-work-related. For example, cancer, mental illness, chronic illnesses, neurological, and degenerative diseases among many others may all be covered by your long-term disability policy.
DENIALS WITH DISABILITY COMPANIES
Companies, such as UNUM, MetLife, Guardian Life, Mutual of Omaha and several others have disability policies. UNUM openly admits to denying almost 10% of all the claims it receives. This is a low number in the opinion of disability lawyers. Most lawyers claim this number should be much higher.
Companies may deny a claim if it doesn’t fall within the scope of the insurance contract. Or, perhaps the policyholder hasn’t complied within the policy’s terms. However, sometimes insurance companies practice bad faith. Companies will deny a policyholder’s claim, even if it is legitimate, by failing to investigate claim or making the process of filling out paperwork more complex than it needs to be. This causes policyholders to drop the claim.
AFTER A DENIAL
Claims are denied often because insurance companies look for every possible legal and technical angle available to deny them. When an insurer does not live up to their end of the contract, it is called insurance bad faith. In addition, other forms of insurance bad faith include partial payments on disability claims, unreasonable denial, delay, or policy termination, concealing benefits from policyholders, and/or misclassifying injuries to prompt claim denial.
LONG TERM DISABILITY ATTORNEY
Consumers need to know that just because their claim is denied, this doesn’t mean their story ends. Insurance companies might deny your claim because, at the end of the day, when they pay fewer claims benefits, it means more money for them. However, denials or low payments aren’t the end of the claims process. If your claim has been rejected, know your rights and options.
Long Term Disability Insurance Denial Results
Call the team here at Sadaka Associates now at 1-800-810-3457 to talk to an attorney about your potential long term disability insurance denial.
Common Policy Points
If a person seeking a benefits plan is not careful they could find themselves in an inadequate policy. Some providers have more options that cover short-term disability and others have more diverse policies concerning long-term disability. Each provider can cover similar aspects in terms of policy, but the exact limitation may range.
What is covered in most plans
Most providers cover key points in their disability policies. The elimination period is a set of time between becoming disabled and filing the claim. This time period may change depending on the provider and their specific policy. An occupation class is the standard set by the type of job you perform. Jobs with a higher level of danger or health risk may have you pay a higher premium than others. The policy definition explains the terms that your policy restricts or classifies your disability. Your status could either be an inability to perform your own occupation or unable to perform any job.
The amount of your benefits is also detailed in your policy. The length of your benefits in each policy varies with long term and short term disability. Long-term disability can last up to retirement and short-term disability can range from a few months to a few years. A policy rider is added benefits that come with an additional premium. These added premiums could be for extra coverage if the policyholder were to get into an accident. Other policy riders can decrease your minimum by limiting your claims for a mental or nervous disorder. There are other riders that depend on your type of policy and the provider that you have. Each state has their own regulations on taxing of those benefits.
If your policy is too limited, your insurer could potentially deny your claim.
Employee Retirement Income Security Act
People in need of disability coverage initially file with their insurance company. There are several providers who carry and support a range of claims. These insurers have benefits for short-term disability plans and others have policies to handle long-term claims. The Employee Retirement Income Security Act (ERISA) was created to help protect those enrolled in plans and their beneficiaries.
Inception and Purpose of ERISA
The Employee Retirement Income Security Act was created in February of 1974 and signed by President Gerald Ford the following September. With the security of the policyholder and their beneficiaries in mind, this bill has been amended several times since then to fit the needs of the worker for each era. In 2013, the total number of plans incorporated 141 million workers and their beneficiaries. This amounted to over $7.6 trillion in assets for those people. Even with these plans, only 54% of American workers earn retirement plans from their jobs, and only 59% have health benefits from their places of work.
Policyholders and insurers should know about this acts in order to not be mistreated. Since its inception, The Employee Retirement Income Security Act has provided a safety net for people with assorted benefits packages. This act requires individuals to be given full disclosure with information about their plan, keeping providers liable.
ERISA enforces provision to ensure that regardless if your place of work goes bankrupt, participants that qualify will still receive their benefits. This also helps prevent abuse or mismanagement of funds for retirement savings. Hopefully, allowing workers to have assurance they will receive their benefits, while holding the companies in charge of the funds responsible.
There are three parts of the government that enforce these aspects of ERISA; the Labor Department’s Employee Benefits Security Administration, the Treasury Department’s Internal Revenue Service, and the Pension Benefit Guaranty Corporation.
Policy Definition & Video Inconsistency
Each provider has a set of guidelines that the consumer agrees to abide by, or criteria that must be met in order to qualify for disability coverage. When some of these standards are not met, this can lead to the provider deny their claim even if the consumer has a legitimate case.
Knowing your policy
A common reason for denial is the failure to meet the criteria for the disability claim. Disability is generally defined as an inability to perform the requirements for your occupation. Consumers with prior substance abuse history or a pre-existing condition may not qualify for disability. Also, those with subjective complaints or tested ailments, such as depression and chronic fatigue syndrome, may be excluded. These subjective disabilities, if granted, may only be given 24 months of coverage.
Other ways that a claim can be denied is if the investigation done into your claim shows that you are not disabled in the way you have stated. Providers can hire investigators to follow you or track your daily habits to compare against the limitations of your claim. If a consumer files a claim and their doctor states that the patient can’t lift over a certain weight and must use a cane when walking, it is in their best interest to do so. They can be denied their claim if they are caught moving heavy groceries or not using a cane to aid themselves.
It is crucial that someone filing a claim with their provider abides by the standards and guidelines of their insurer. This gives them less leverage to bring against your claim. Adhere to the criteria of the claim to insure that you are given the assistance that you are entitled to by your provider.
Misinformation and Missed Deadlines
Those fortunate with insurance lean on those companies to give them peace of mind when they need financial support. In many cases, these companies will pay partial or no money to their consumers. These denials can be made for several reasons.
Why it was Denied
Insurance providers deny claims that are perfectly valid. Some insurers will not approve a disability claim without proper, periodically updated, and current medical information. A consumer that does not receive enough treatments or check-ups, may be denied a disability claim. Along with this, if any valuable records are missing, whether they are foolishly or accidentally misplaced, this may also lead to the providers’ rejection of your claim. The consumer’s primary care physician’s statement may be most valuable in these claims. This statement should be detailed and explicitly state why a disability claim is valid. The lack of any information could result in a denial.
Another reason for denial is the consumer filing or submitting relevant information passed the given deadline. Most claims governed by ERISA (Employee Retirement Income Security Act) give 180 days after the initial denial to appeal. After the denial is when a long-term disability (LTD) lawyer should be contacted. Those who fail to file all of their paperwork by the deadline are not given a court hearing to properly plead their case.
The information needed for a proper disability claim can be the most tedious to track. This can be frustrating to some who are seeking immediate assistance from their provider. It is best to make sure all files are submitted as soon as possible and any medical forms are kept up to date. If you or anyone else is having issues with a long-term disability claim, contact a long-term disability lawyer.
Providers of Disability Coverage
Different providers have various policies that can help you when an accident occurs. Be sure to investigate them to see which provider has the best plan for you.
Companies with disability plans
Rated by A.M Best, a company created to give policy seekers a rating standard when looking for a provider, these companies have become some of the leading policy providers for disability. MetLife offers three different plans for consumers with different needs. One plan is customizable for those in the medical field and knows exactly what they need, as well as also a general plan for executives and medical professionals. Their third plan, OMNI Essentials, is meant for those on a budget.
Principal Financial Group is a long time running coverage provider that started in 1879. This company does claim to accommodate those seeking pay adjustments for people returning to work and accelerated pay if the policyholder has a terminal illness.
Guardian Life, founded over 150 years ago in 1860, offers four different plans for disability policies. Guardian is known to offer a disability plan that covers disability of your own occupation. They also have benefits periods in two, five or ten years, up to retirement age, depending on what your occupational class states.
The Hartford has been covering people for over 200 years. They offer vocational and rehabilitation plans to employers, as well as family care credit, and workplace modification benefits. This provider also covers returning part-time workers and no limitations for workers with pre-existing conditions.
Another well-known provider is Mutual of Omaha. They offer both short and long-term disability insurance. With these policies, riders can be added to each plan to increase their specific disability status.
Be aware of Policy Riders
Extended coverage policies can be added for increased premiums. These policy riders are available to accompany any plan that you feel might need them. Some offer riders that reduce your premium and other increase it to cover more specific aspects of each policy. Providers may also cover non-work related disabilities and maternity coverage. If any provider denies your claim for disability coverage, contact a long-term disability lawyer.