Disability Claim Denial Lawyers
Due to an accident or an illness, you may need to claim disability benefits to cover your loss of income for a period of time.
Short Term Disability and Long-Term Disability Claim Denial Lawyers
There are, generally speaking, two types of disability insurance coverage:
- Short Term Disability (STD) coverage; and
- Long-Term Disability (LTD) coverage.
Disability coverage ensures that you and your family are protected if you find yourself unable to work due to an injury or illness. The nature of your disability will dictate the coverage you’ll need. Short term disability insurance helps cover expenses, typically for up to six (6) months, while you are recovering from your illness or injury. Long-term disability coverage then begins after your short-term disability insurance runs out.
Own Occupation vs. Any Occupation Period
Once you’ve begun to receive long-term disability benefits there is usually two definitions of disabled you need to meet to be entitled to benefits under your insurance policy.
The first is the definition of being disabled from your own occupation. This is usually the definition of disability you need to meet to qualify for long-term disability benefits for the first two years of your disability (although this can differ depending on the terms of your insurance policy). The specific wording is policy dependent but generally you are required to be unable to complete the substantial demands of your own employment due to illness or injury.
However, after the own occupation period ends, often after two years of long-term disability, the definition of disabled under most policy changes and in order to qualify as being disabled under your insurance policy you must be disabled from performing the substantial demands for any occupation that you are reasonably suited for due to injury or illness. This is referred to as the any occupation definition of disability and is a much higher test to meet than that of own occupation disability.
Understanding the distinction between the own occupation and any occupation definitions of disabled under a policy of disability insurance can be critical.
Common Reasons Disability Claims Are Denied
There are numerous reasons disability claims are denied. Some of the most common reasons are:
- A material misrepresentation in the insurance application
- A change of definition of “disabled” under the terms of the policy
- A failure to adhere to the terms of your disability policy
- A failure to provide sufficient evidence of disability
- The insurance company believe that you are not completely disabled
- The insurance company believes you are still able to work
- Your injury or illness has no objective signs or symptoms
- Your insurance company believes you could work in another line of work
- An unclear or wavering medical diagnosis
- A failure to be under the care of a doctor
- A failure to follow reasonable treatments
- A refusal to participate in a return to work program
- Your disability relates to an excluded cause of disability under your policy
- Failure to notify your insurance company of your disability in time
Remember, just because an insurance company is telling you they have a good reason to deny your claim doesn’t make it so. Unfortunately even if you do have a good argument that often isn’t enough to stop insurance companies from denying legitimate disability claims.
Has Your Disability Claim Been Denied?
If your disability insurance claim has been denied, please contact our experienced team of disability insurance lawyers. The lawyers at Taylor & Blair LLP will be able to review your policy, explain the legal issues to you in plain language you understand, and help you can make informed decisions about your options. We will work hard to make sure you get what you are entitled to.
Proving a disability claim, no matter how legitimate, can be difficult. Insurance companies may deny your claim for a number of reasons, sometimes for no other reason than to support their bottom line. Insurance companies may use medical evidence and policy restrictions to avoid payouts. This is why it is important to make sure your medical practitioners are on your side. The lawyers at Taylor & Blair LLP understand how important having a doctor support your claim is for a good outcome and we have a network of medical specialists we regularly use to help make sure our client’s get the most out of their claims. Insurance companies may even go so far as to monitor your social media accounts or hire private eyes to follow you and record video of your daily life to try to undermine your claim.
Disability Claims & Timelines
Insurance companies will offer you the chance to appeal their decision through their internal appeal process. While this may sound hopeful, keep in mind you will be appealing to the same insurance company who has already decided to deny your disability benefits. Often you will have provided all the relevant medical information so you have to ask yourself why they would change their decision? What insurance companies are often doing is hoping that through the lengthy appeal process your time limit to file a lawsuit expires and you lose the right to force the insurance company to pay you the disability benefits they owe you.
Most people don’t appreciate it but timelines matter for disability claims. There are often time limitations in place in your insurance contract that will prevent you from taking legal action after receiving a policy denial. Depending on the terms of the policy this timeline can be anywhere from 1 to 2 years, or longer. While a year may seem like a long time, it goes fast, especially when dealing with a disability and an insurance denial. It is important to move quickly when looking for legal advice. If you have a denied disability claim contact that lawyers at Taylor & Blair LLP today.