What To Do If Disability Insurance Company Denies Your Claim

Why Disability Insurance is Important

Disability insurance is a method by which an employee gets a fixed sum of money (usually a percentage of the paycheck) if they get hurt on the job or fall sick and unable to work. Most employers offer disability insurance to their employees – about 60% of salary. It is easy to buy extra insurance through employer programs or even on one’s own. Disability insurance also covers disorders like musculoskeletal problems and issues like sciatica and arthritis.

Why Disability Insurance Claims Are Denied

No one likes to find out that their claim for disability insurance has been turned down. Most often than not, insurance companies tend to turn down claims and will provide explanations for the same. Some of the reasons could be:

  • Lack of Objective Findings : If a claim cannot be backed up by medical evidence like x-rays, lab results and doctor reports, it will likely be turned down.
  • Pre-existing Conditions : If a policyholder has a condition for which they were treated not too long ago, it could be grounds for denial.
  • Elimination period : Most policies require that the claimant be unable to work for a period of 1 to 6 months to become eligible for benefits. If there is improvement, then the benefits are not made available.
  • Doctor Care : If a person doesn’t meet with a physician on a regular basis, this is considered grounds for denial.
  • Self-diagnosis : Some policies have specific clauses that exclude a patient’s reporting of symptoms which are difficult to document.

How to Appeal a Denied Claim

It is always a good idea to work with a lawyer who is well versed with the labor laws and insurance claims. Some of the things a claimant has to do are:

Copy of Policy

Get a copy of the insurance policy along with supporting documents. HR departments in companies can provide this information. Going to the insurance carrier is another option. Put the request in writing and ensure that it is signed for.

Reviewing Denial Letter

Read the letter carefully and pay attention to the reasons offered for the denial. There may be information on what is needed to get the claim approved upon re-filing. If a deadline for appeals is mentioned, act immediately.

Hire a Lawyer

Talk to a lawyer and hire one as soon as possible. Make sure that they are well versed in ERISA law which deals exclusively with disability insurance. Lawyers will know the right experts to get opinions and the right paperwork. Discuss lawyer fees before hiring.

Documents to Include For New Claim

It is important to include all the paperwork so that a claim is not turned down for a second time. Some of the paperwork could include:

Missing Records

Very often, insurance companies and plan administrators don’t ask for all the paperwork needed to process a claim. With the help of a lawyer, it should be easy to fill in the gaps. Make sure to get confirmation that the required documents have been received by the claims department.

Medical Tests

The more medical evidence that is provided, the higher the chance of getting a claim approved. Include as many test results as possible with paperwork to expedite the claims process. X-rays, results of blood work, MRIs and other scans play an essential role. Doctors can also provide written opinions about your case and offer insights into health issues.

Expert Testimony

Some kinds of evidence (not medical) can help make a case. Get family and friends to offer written testimony about your disability. Vocational training experts are good sources for such letters as well.

If all of the above steps don’t help in getting the claim accepted, the last step would be to file a lawsuit. This could be a long process and one of last resort. Work with a good lawyer with experience in disability law to get the necessary help.

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