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This Is What Happens When A ERISA Disability Policy Holder Is Left High and Dry > Long Term Disability  > This Is What Happens When A ERISA Disability Policy Holder Is Left High and Dry

This Is What Happens When A ERISA Disability Policy Holder Is Left High and Dry

ERISA Disability Claim Appeals

You purchase a long term disability policy to provide you with peace of mind if you became sick, injured or disabled.

Unfortunately, long term disability carriers don’t make it easy for the disability policyholders to get the disability benefits they deserve.

Understanding The Disability Insurance Claims Process

There are 4 possible scenarios in the claims process.

  1. Be sick, injured or disabled people but haven’t yet filed a claim;
  2. Applied for benefits and are waiting for a decision of coverage;
  3. Been denied in the appeal process stage or;
  4. You exhausted the right to appeal the claims denial.

Sick, Injured Or Disabled But Not Yet Filed A Claim

It can be difficult to make the decision to file a claim for disability benefits.  You should understand that many disability policies have time limits on when you must file a claim.  It’s time for you to get out your disability insurance policy so that you will understand what the policy covers, how to file a claim and when you must file a claim.  If you file your claim late, your claim can be denied on the basis that your claim was late and the carrier was prejudiced by your late notice.

Applied For Benefits And Waiting For The Carrier To Make A Decision.

If you’ve applied for disability benefits you should send your application and supporting documents to your disability carrier by certified mail return receipt requested so that you have record that your appeal has been received.  If you haven’t heard from the disability carrier in 30 days, you should call the Adjuster and ask about the status of your claim.  If they haven’t made a decision within 60 days,  it’s time for you to retain the services of a disability attorney to help you get the disability benefits that you deserve.

Your Application For Benefits Has Been Denied And Your In the Appeal Stage.

Many disability claims are denied on the basis that:

  1. There is no objective basis or diagnosis;
  2. There is no objective basis for the restrictions or limitations as signed by your physician; or
  3. There is no causal relationship between your restrictions and your ability to do your own or any occupation.

Long term disability carriers also have many other reasons for denying valid claims.  They deny claims in an effort to discourage you from pursuing the benefits that you desperately need.

If you purchased your policy through your employer, the ERISA statute, which governs your policy, provides that you have the right to file one appeal with your insurance company.

Some disability carriers often offer a second level of appeal.

Your appeal is the trial of the case and this isn’t the time to be a do-it- your-selfer. ERISA disability attorney Nancy L. Cavey writes appeal letters that are 30 to 60 pages long and develops the medical and vocational evidence to establish a time limit to benefits.  In an ERISA case there is no ultimate trial if you have to file a lawsuit.

You’ve Exhausted Your Administrative Remedies And It’s Time To File Suit

Once you have exhausted your administrative remedies, you have the right to sue the insurance company.  If you have an individual policy that lawsuit will be filed in State court if you have an ERISA claim your lawsuit must be filed in Federal court.  One serious mistake you can make is to delaying filing suit because many policies will provide the time in which to file a lawsuit runs from the time of you are required to give notice and not from the time of the last denial.  This crucial mistake can mean your lawsuit is dismissed with prejudice and cannot be refiled.

The Ugly Truth

It’s Time To Get Representation No Matter What Stage Of The Claims Process.

Nancy L. Cavey handles disability claims from the initial application through appeal and litigation in State and Federal Courts.

Don’t let the insurance company rob you of your peace of mind.  Contact Attorney Cavey for a no obligation case evaluation at (727) 894-3188.

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