long term disability benefits

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Long Term Disability Denial | What is Erisa

You are probably either very upset that you’ve been denied your insurance right now, or searching online to be sure you do not run up against a denial. Either way we hope this article helps you understand what you’re up against and gives you some ways to get through this complex system.

Disability Insurance LawyersERISA, Employee Retirement Income Security Act, which was original enacted in the 1970s was meant to preserve your retirement income. The Act has been amended many times since then and now under most cases requires the insurance company who may or may not pay you, the power to deny your benefits, rather than an impartial jury of your peers, or a court appointed judge.

According to the Department of Labor’s website:

Federal retirement law requires all plans to have a reasonable written procedure for processing your benefits claim and appeal if your claim is denied. The Summary Plan Description (SPD) should include your plan’s claims procedures. Usually, you fill out the required paperwork and submit it to the plan administrator, who then can tell you what your benefits will be and when they will start.

The only problem with this, is that under ERISA a “plan administrator” works for the insurance company and may deny your benefits even if your claim is a deserving one.

Long Term Disability Denial | How Can You Avoid Denial?

INSUFFICIENT MEDICAL EVIDENCE: One of the top reasons for denial is insufficient medical evidence. This can happen for a few reasons. Maybe you didn’t realize how important regular medical treatment would be for your case to be approved. If you have a physical ailment you should be seeing doctors regularly which would include testing such as x-rays, blood work, MRI scans or any other tests that would pertain to your physical condition. If you have a psychiatric condition, your insurer would expect you to have regular visits to a psychiatrist or psychologist monthly at the very least.

MISSING MEDICAL RECORDS: Sometimes a denial can occur because of missing medical records. Even when you provide all your medical records as evidence, the insurer may not have all of them in their files. Some persistence may be required, you or your attorney should ask for all medical records to ensure that all of them are in the possession of your insurance company.

DOCTOR’S STATEMENTS: Another and possibly one of the most important aspects of your case would be making sure that your doctor’s statements on your records are detailed. Often a doctor will state “doing fine” or “doing better”. This may be because your doctor is encouraged by you having a better day, but you could still completely disabled. To anyone reading the report, they won’t understand what this means. Be sure your doctor accurately describes your condition at each visit.

FREE DISABILITY EVALUATION

Does applicant…

* indicates required

currently receive disability?
expect to be out of work for 12 months?
have an attorney helping with the case?
receive doctor's treatment in past 6-12 months?

PLAN DESCRIPTION: You may fail to meet the policy’s plan description for the precise definition of your disability. Having a lawyer who has focused his or her practice in Long Term Disability Denial will be able to read your policy and look at all your records to help you determine if you can win your long term disability benefits.

MISSING DEADLINES: Another big reason for denials is missing deadlines. This is another reason to get help for a lawyer experienced in ERISA claims.

If a worker does not follow ERISA’s requirements to the letter, particularly with deadlines and claim requirements, their claim may be denied with no opportunity to appeal. Additionally, if an employee skips a step in the ERISA disability benefits claim process (such as skipping an appeal), a future claim in court may not be allowed to proceed. – Findlaw

VIDEO SURVEILLANCE: On another note, in some cases, the insurance company will hire someone follow you, and even shoot video to see that in your every day life you truly are disabled. Always act in accordance with your doctor’s instructions to avoid getting a denial or having benefits revoked.

Long Term Disability Denial | Getting Help

If you need help getting your long term disability insurance, look for an experienced law firm that works with disability insurance carriers every day. Don’t give up. It never feels like a level playing field but with the help of an experienced law firm you’ll have someone on your side.