When you suffer from a long-term disability, you need your benefits from your disability insurance company as soon as possible. The last thing you want to receive is a denial of your claim.
Receiving a denial means it will take longer to receive your benefits. When you purchase your disability insurance from your employer, you must follow the ERISA appeal process to appeal your claim.
When you want to improve your chances of getting approval for your claim, speak with a San Mateo long-term disability lawyer at Roberts Disability Law, P.C.
The Employee Retirement Income Security Act (ERISA) is a federal law that protects the financial benefits of workers. Because of ERISA, your employers are required to inform you of how you can file your claim for benefits and how you can appeal a denial. ERISA also protects your benefits packages from being violated by your employer or insurance companies.
Your insurance company will deny your disability claim for failing to remain in communication, not meeting pre-existing conditions clauses, lacking sufficient evidence, and more.
Some claimants make a mistake of only communicating with the insurance companies when filing for benefits. Even after receiving benefits, insurance companies will still need certain information, especially if you apply for long-term disability benefits.
Insurance companies will ask you for certain information to determine whether you still meet the qualifications for disability. Failure to continue communicating with the insurance companies will cause them to deny your benefits.
Insurance companies can also deny your claim due to a contractual exclusion clause. Some long-term disability policies have pre-existing condition clauses that prevent claimants from filing for benefits within one year after their policy has been effective.
If the insurance company finds out that you had a pre-existing condition before applying for your insurance, they can use your condition to deny your claim.
Insurance companies can also deny your claim when no medical evidence backs up your disability. Some claimants think that certain medical evidence is enough to justify their disability. This information can be blood tests, X-rays, and physician visits.
But some insurance companies require more information that can speak to the severity, frequency, and duration of your disability. This information may not be enough. In other cases, insurance companies may not agree with your doctor’s opinions about your disability.
Some insurance companies may ask you to participate in an independent medical examination (IME) if they disagree with your doctor’s opinion. During an IME, the doctor will ask you specific questions about your disability, like the restrictions and limitations that it causes. You may have the right to refuse participation in an IME, but the insurance company can use that to deny your claim.
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