If you were seriously injured and are unable to work, you could be eligible for long-term disability benefits. Unfortunately, insurance carriers like to make the claims process difficult. Even though you might be entitled to these benefits and have spent years paying your premiums, they can wrongly deny your claim or reduce or terminate your benefits without warning. If this has happened to you, the Employee Retirement Income Security Act makes it possible for you to appeal the decision.
Whether you are having a hard time with the application process or would like to file an appeal, you need to consult with a Philadelphia long-term disability attorney right away. Both your time to file a claim and your time to file an appeal are limited. If you fail to meet these deadlines, you will lose your right to file. For more details, contact Edelstein Martin & Nelson in Philadelphia.
An experienced attorney will understand how important it is that you receive your benefits as quickly as possible. When you are sick or injured and unable to work, medical bills can pile up at an alarming rate. A skilled Philadelphia long-term disability claims lawyer will fight to ensure you receive the benefits you deserve.
What Is Long-Term Disability Insurance?
The purpose of long-term disability benefits is to act as a substitute for a worker’s income should they develop an illness or injury that renders them unable to work. Disability benefits are typically paid at 50% to 80% of the wages the claimant was earning just before they became disabled.
Most people acquire long-term disability insurance through their job. In some instances, they pay a premium, and in others, their long-term disability premiums are part of their total benefits package.
When a worker has long-term disability coverage, their benefits usually kick in when their short-term disability coverage ends. Depending upon their specific insurance policy, this could be anywhere from ten weeks to a full year after their qualifying event. Based on the terms and conditions outlined in their policy, the disabled worker might also receive rehabilitation to help them return to gainful employment.
What Can a Long-Term Disability Claims Attorney Do For Me?
Long-term disability insurance plans provided by employers are overseen by federal law. This law, known as the Employee Retirement Income Security Act, was originally created to protect workers, but as so often happens, over the years courts have begun to interpret elements of ERISA so that the interests of insurance companies are prioritized over employees.
In addition to this, the law also incorporates an intricate web of deadlines that have to be met when making a claim. These are often just one more obstacle for policyholders to overcome. By partnering with a skilled long-term disability insurance lawyer, you will be able to successfully complete the application or appeal process and maximize your odds of being approved for disability benefits.
Since insurance companies have a vested interest in the results of each case, the decisions they make regarding benefit approvals are, sadly, not always based on evidence and facts. Disability law is multifaceted and complex, so your claim is more likely to be successful if you work with a lawyer who concentrates solely on these kinds of cases.
An experienced attorney will know the most efficacious methods of gathering relevant evidence, be in compliance with all deadlines, skillfully negotiate with the insurance carrier, and if necessary, litigate your case.
Common Reasons Long-Term Disability Claims Are Denied
Filing a long-term disability claim is an experience most people find challenging, time-consuming, and generally overwhelming. Sadly, long-term disability companies treat all claims as though they were fraudulent. Adjusters scrutinize the applications of hopeful claimants, looking for any small error they can use to deny an otherwise valid claim.
Some of the most common reasons for claim denials include:
The definition of disability: The definition of a long-term disability varies from insurance company to insurance company. Most policies also include exclusions that bar you from receiving benefits for certain types of injuries or accidents.
Procedural errors: When applying for long-term disability, there are numerous deadlines that must be met. Missing even a single step or submitting your records just one day after the deadline can and will jeopardize your ability to receive benefits.
Missing medical records: A major part of the application process includes submitting documents from your doctor that prove you have the illness or injury for which you are claiming disability. This documentation should include any official paperwork that relates to your condition, such as physical therapy bills, hospital records, letters or notes from your doctor, and receipts for any prescription medications.
Conflicting information: Every piece of information you submit to the insurance carrier will be evaluated and reviewed. If there is even a single, tiny discrepancy, that will give the reviewer ample reason to deny your claim.
Bad faith insurance: In an attempt to decrease their company’s overhead, some insurance adjusters will deliberately deny claims even though they meet the requirements laid out by the policy. Others refuse to investigate claims thoroughly or deny requests without looking at a single shred of evidence. These are all acts of bad faith.
Rare medical conditions: Many insurance adjusters will deny claims simply because they do not understand or have not previously heard of a particular medical condition. In this case, an attorney can help you prove the validity of your condition by presenting medical records from specialists that provide details as to your illness or injury.
Regrettably, most disability claimants lack the resources and specialized knowledge that are needed to challenge an insurance company. An experienced long-term disability claim attorney will work closely with you to obtain all essential documentation needed to evaluate and substantiate your disability claim.
During the application process, they can ensure you understand each stage of the process, including what occupational, financial, and medical information has been submitted to the insurance company and why. hen necessary, they can also work closely with medical and financial specialists to prove the validity of your claim.