Appealing a Disability Insurance Denial
Legally Reviewed and Edited by: Terry Cochran
If a short term or long term disability, illness, or injury impairs your ability to work, you may be eligible for disability benefits, a portion of the income you would have earned, from your insurance provider.
Many insurers wrongly deny disability claims. If you have been denied long term disability insurance, consider filing an appeal with an experienced attorney at our law firm to help you get the coverage you deserve.
About Disability Insurance
Disability insurance protects your income against losses caused by medical conditions that prevent you from working. If your long term disability claim is approved, you might get as much as 70% of your pre-disability income in insurance benefits, depending on the plan you purchased.
If your insurance plan is employer-provided, it is likely federally covered by the Employee Retirement Income Security Act of 1974 (ERISA). This law sets the standards to protect individuals covered by health plans and retirement plans by private insurance companies.
Why Claims Are Denied
Wrongful disability denials can be caused by errors within the claims processing procedure or bad faith acts. The insurance company may insist that your disability was preexisting, does not limit your ability to work, or does not merit additional benefits after social security disability benefits.
If an insurance company denies your claim, they are required to disclose the reason it was denied, instructions for filing appeals, and deadlines for appealing the claim.
Steps To Take After Claim Denial
If your insurance claim was denied, you’ll want to follow the proper appeals process closely to avoid damaging your case.
Gather all your relevant medical records before appealing a denial. You also have the right to review the documentation that the insurance company reviewed with the original disability insurance application. This can clue you in on incomplete or misleading information that may have caused the company to deny your claim.
It’s important to retain an experienced attorney to help you appeal your case. Missteps in the early stages of appealing a decision can have major negative implications later on in your appeals process, and you will likely need help making a strong case to the reviewing court.
If your insurance plan is regulated under ERISA, you’ll have to exhaust the administrative appeals options before filing a lawsuit. Your lawyer can guide you through the many steps of the appeals process to keep your insurance claims going in the right direction.
Reversing Long Term Care Insurance Benefits Denials
Cochran, Kroll, & Associates, P.C. successfully appealed an insurance denial for a client suffering from the early stages of Alzheimer’s Disease. Consequently, the insurance carrier awarded the claimant the long term care benefits she deserved.
CNA, an insurance carrier, sells insurance policies with long term care benefits to elderly customers. Claimants are assessed for disability based on how many of their daily activities are impaired by disability.
After hiring a registered nurse to interview the claimant, CNA decided the claimant was not hindered in enough daily activities to be eligible for the disability benefits.
During the appeal, the lawyers at Cochran, Kroll & Associates, P.C. added relevant documentation about the claimant’s medical condition and treatment at the nursing home. A registered nurse treating the claimant also signed a document attesting to the assistance the claimant needed to perform daily activities.
Appealing A Mental Condition Insurance Denial
After MetLife Insurance Company denied a disability insurance claim on the grounds that the disability preexisted insurance coverage, the claimant turned to Cochran, Kroll & Associates, P.C. for help appealing the wrongful decision.
The claimant suffered from post-traumatic stress disorder, which MetLife Insurance insisted resulted from serving in Iraq, pointing to the claimant’s discharge for PTSD as evidence.
Cochran, Kroll & Associates, P.C. showed that the client’s current PTSD resulted from his current work as an undercover agent. A psychiatrist examined the client and provided the credible opinion that because the client had been able to resume a normal life without treatment following his military discharge, his PTSD resulted from his current work rather than past military service.
MetLife Insurance then awarded long term disability benefits to the client.
Choose Cochran, Kroll & Associates, P.C.
Retaining a lawyer with experience in appealing disability insurance denials is important for receiving a favorable outcome. As you search for a law firm to handle your claim, look for one with a winning record in disability insurance cases. Cochran, Kroll & Associates, P.C. has such a record.
Contact us today at 866-MICH-LAW to schedule a free consultation to discuss the next steps for your insurance appeal.
Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.