Your rights under a private or individual disability (ID) policy are very different than an ERISA policy.
When you bought your disability policy you and your insurance company entered into a written contract for the carrier to pay you disability benefits if you became disabled. If you meet the terms of the policy, including the definition of disability, you are entitled to your benefits. It is a simple as that.
So, if your disability carrier is
(1) playing games with your application, requesting more and more information, and have delayed making a decision,
(2) denied your initial application, or
(3) stopped paying and denied your continuing monthly disability benefits, they may have breached the contract.
There may be a number of legal claims that can be brought against the carrier in state court.
Appealing A Denial Of Your Private Or Individual Disability Benefits
Most private or ID policies will require that you appeal the denial of your benefits. Unlike an ERISA appeal, the appeal of the ID denial is not the trial of your case. If benefits aren’t paid, you have the right to sue your disability carrier in state court which is a much friendlier place for a policyholder to be!
The appeal process is much like an ERISA appeal. A simple statement that you are appealing the claims denial isn’t worth the paper it was written on or the postage to send the envelope. Sending in more medical records isn’t an appeal.
Disability carriers don’t always make it clear why your claim was really denied and what information you must submit to get your benefits. While the denial letter will give a clue why the claim was denied, the gold is found in the carrier’s file.
It takes about 30 to 45 days to get the carrier’s file. Nancy will read your file from beginning to end and often finds 10 to 15 mistakes the carrier has made- mistakes that policyholders just don’t know about.
She works closely with you, your physicians, your family and even hires vocational evaluators and functional capacity evaluators to develop the necessary evidence to create a shock and awe appeal. The goal is to take apart every reason the carrier is using to deny your claim and explain every reason and piece of evidence that proves why you are entitled to your disability benefits.
Many disability policies have a 180 day period in which to file an appeal. The length of the appeal period can vary from policy to policy. While 180 days sounds like a lifetime, it often takes that long to gather the necessary information, schedule and complete our functional capacity evaluation (FCE), vocational evaluation (VE) and the statement of you and your physicians.
Nancy writes every appeal which ranges in length from 25 to 60 pages. She creates the shock and awe appeal package in anticipation that a lawsuit may be filed if the Appeal is denied. It is all in black and white and is sent to the Department of Insurance, as appropriate, to set up a bad faith claim against your carrier. Unfortunately, not every state allows a bad faith claim.
Of course, anything new that happens during the appeal period, such as new medical information or an award of Social Security benefits, can improve your chances of getting your benefits.
Many times the disability carrier will rely on confusing or unclear policy language to justify delaying and denying your benefits. It takes a skilled attorney to write a winning appeal. The whole purpose of the appeal is to give the carrier pause and the last chance to pay your benefits.
Disability attorney Nancy L. Cavey is known in the disability insurance industry for her shock and awe appeals and her tenacious approach in the claims appeal process.
Generally, the policy will provide a time period in which the carrier must make a decision on the appeal but this varies from policy to policy. During the appeal period, your carrier may ask that you undergo an IME or an FCE.
The carrier can reverse the denial and pay your benefits or deny the appeal, at which time Ms. Cavey will recommend suing your carrier.
It Is Time To Hire Nancy L. Cavey To Handle Your Private Individual Disability ID Appeal
If you get a letter denying your claim, call Nancy L. Cavey for a free no-obligation consultation to learn how you can get your benefits at 727-894-3188 today. You may have a limited time period in which to file your appeal. Only a shock and awe appeal letter and package with the right medical and vocational evidence will get the attention of your carrier.
1 – Represent yourself,
2 – Send the carrier a letter saying “I appeal!”,
3 – Pester your doctor to give a rebuttal statement when you don’t know what you are rebutting,
4 – Try to rebut the carrier’s vocational opinions by saying that wasn’t your occupation, occupational duties or you just can’t work because your employer won’t accommodate you,
5 – Ignore surveillance, and
6 – Ignore what the adjuster says in the claims notes.
Nancy L. Cavey has flexible fee arrangements for preparing and filing the appeal. The fee options include a flat fee or hourly fee but more often she handles an appeal on a contingency fee basis. That means she doesn’t get paid a fee unless she gets you your disability benefits.