Every day, thousands of people are involved in disabling accidents or are diagnosed with life-threatening conditions. For this reason, many employers offer their workers long-term disability insurance, under which the employees can collect benefits in the event that they suffer from a disability. Employers are not required to offer these types of policies, and so many people choose to purchase a policy from an independent insurance broker. While these benefits give many employees peace of mind, the reality is that some companies refuse to pay valid claims, whether out of negligence or as the result of bad faith practices.
Fortunately, those whose claims have been wrongly denied do have legal recourse, so if you are a California resident and your claim was recently denied, it is critical to speak with an experienced long-term disability attorney who can address your questions.
To file a claim for long-term disability benefits, a claimant must fill out a variety of forms and provide medical records documenting the doctor’s diagnosis, opinion, and suggested treatment. The doctor must also explain what restrictions and limitations the claimant faces and how those restrictions prevent them from doing their job. Unfortunately, despite submitting the necessary evidence, many claimants are denied benefits. Some of the most common reasons used for denying coverage include:
Fortunately, those whose claims are denied for one of these reasons can appeal the decision immediately.
It is possible for a claimant whose request for long-term disability benefits has been denied to appeal the decision. The process for appealing will depend largely on what type of entity provided the policy. For instance, claimants who obtained coverage through a private insurer can file a lawsuit directly with a court. Claimants who receive benefits from an employer, however, must comply with different procedural requirements. This is because all employers, with the exception of government bodies and religious organizations, are required to adhere to the terms of the Employee Retirement Income Security Act (ERISA).
ERISA gives employees certain rights during the appeals process. For instance, a company or its insurer must respond to a claimant’s appeal within 45 days of receiving it, although they can request an additional 45-day extension for a total of 90 days. The law also requires employees to comply with certain procedural requirements, as they must file an administrative appeal no later than 180 days after receiving the denial. Only after these procedural hurdles have been met can a claimant appeal the decision in court. A plaintiff cannot seek punitive damages even if they believe that the insurer acted in bad faith, but is restricted to seeking the benefits denied under the policy.
Please contact Roberts Disability Law, P.C. to schedule a consultation with a dedicated long-term disability attorney who can evaluate your case and address your concerns.
LEAVE YOUR MESSAGE
We know how to get your insurance claim paid. Call today at: