Disability Insurance Denials
It is a common scenario that insurance companies who have sold you a disability policy attempt to terminate benefits claiming the disability are no longer present, or severe enough to prevent employment. This most commonly occurs between two to four years after receiving the benefits depending on the type of language in your contract. Most disability insurance policies include a period ranging from two to four years after which the definition of total disability changes.
The definition typically narrows which is generally bad for the policyholder. This change may take the form of either increasing the number of occupations that should be considered before determining if you are disabled, or narrowing the requirements to meet ongoing disability.
Furthermore, disability policies include the right of the insurance company to obtain your medical records and to periodically have you examined to determine if you are still disabled.
If you and your physicians know that you are still unable to work, then a swift and thorough response must be made when an insurance company notifies you of their intent to limit or terminate your benefits under the disability policy.
Typically speaking the insurer will notify you in writing and provide you with its reasons for the elimination or termination of your benefits. This letter also includes important information concerning how to fight the insurance company’s decision. First, the letter should give you the necessary directions on how to contest the decision.
Most disability policies have provisions requiring an appeals process before a suit can be filed. Whether or not these particular appeals must be followed is a legal question that can only be determined after it is known which laws apply to your particular insurance contract.
However, it is generally advisable to follow the appeals process as it is your first opportunity to have the decision reversed. The letters should also advise you of the policy terms, conditions, or exclusions which the insurance company identifies as part of the agreement entitling them to terminate or eliminate your benefits.
Notably, insurance companies do not always interpret these provisions correctly and therefore they need to be reviewed closely to determine if the insurance company is relying on the proper language, omitting relevant language, or misinterpreting the language. Finally, the letter will also list the specific reasons the insurance company claims that you do not meet the criteria for disability. This information constitutes the facts that the insurance company is relying upon to make their determination and should be a primary focus of your attack.
If you have received such notice of termination or termination letter from your insurance company, it would be prudent for you to seek knowledgeable attorneys in insurance claims disputes. However, if you wish to proceed on your own, you should familiarize yourself with all three elements of the letter above and adequately educate yourself to understand the contract language, the applicable law, the time, method, and process for appeal, as well as the contested fact issues.
To contest the insurance company’s decision, you should immediately gather medical evidence to support your position that you are disabled. This information will come from your medical records and even more appropriately you’re treating physicians. You should contact each of your treating physicians and provide them with a copy of the insurance company’s termination letter.
Ask your physicians, if they still believe that you are disabled, to write letters explaining in detail the medical reasons which lead them to conclude that you are disabled. The doctor should also include their opinion that you continue to be disabled in their letter.
You should also write the company and ask them to provide you a copy of your claim file, as well as any documentary evidence they have supporting the facts that they have relied upon in making their decision.
In doing this, you should be aware that insurance companies are subject to laws that have been adopted in each of the 50 states in the United States regarding fair claims practices. Most State Departments of Insurance has adopted specific regulations on how to implement these fair practice claim acts. For instance, most states have specific requirements about the period in which an insurance company should respond, and specific types of information they must provide to you. In addition, the common law has developed legal rules that apply to insurance companies.
You should properly prepare your appeal and supply all necessary documentation to the insurer before the stated deadlines.
Your letter should include a statement indicating that you disagree with the decision of the insurance company as well as your reasons for the appeal. This would be based on the medical records and evidence you have obtained from your doctors, as well as the appropriate contract language, and applicable law.
You may also wish to contact your state department of insurance and file a complaint. If you do so, you may wish to include a copy of the complaint with your appeal.
Undertaking an appeal of a denial of benefits requires knowledge, skill, and determination. If you are unable to take up this challenge yourself, then you should contact an experienced insurance claims dispute attorney to assist you with your appeal, and if the appeal is denied properly file suit on your behalf so that you can receive the benefits of the insurance policy which you bought and paid for.
