|Wade Coye, Disability Attorney|
You may depend on long term disability insurance coverage if you are hurt and can't return to your job. You will lose wages and have to pay for medical bills, all while continuing to support yourself and your family. You need to know that insurance companies use legal loopholes and provisions in the policies to resist paying adequate benefits or any benefits at all. They make it seem like they're trying to help you if you become injured or sick, but keep in mind that they are still a business and want to make a profit. It seems that the insurance company is least cooperative in the most desperate times for their customers.
If you want to file a claim with your long term disability insurance company, the policy will usually require you to file for Social Security disability benefits. You would think that different decisions mean different consequences, but the insurance company can use approval or denial of Social Security disability benefits to reduce or deny your claim.
Getting approved for Social Security disability benefits isn't easy, so you'll probably feel relieved if you get a notice of award in the mail. But if you're approved, the disability insurance company will reduce your benefits or make you reimburse them for the amount you receive from Social Security. The same goes for any of your dependents who receive benefits checks because of your disability. The insurance company seems to take any chance they can to reduce your benefits, even if those other benefit checks are going to your children or spouse.
Depending on the terms of your policy, a denial letter from Social Security may turn out as a convenient way for the insurance company to deny your claim. They might say that being denied for Social Security justifies being denied long term disability benefits because the requirements for both programs are the same. If your claim is denied, there is also little you can do in the appeals process.
Some insurance carriers hire representatives to help their customers apply for benefits from the Social Security Administration. You should know that these individuals might be working in different states, never meet you, and never truly understand the nature or impact of your disability. Before you agree to accept their help, think about whose interest they have at heart. A representative will work to defend the interests of the company that signs their paycheck. They analyze your policy, looking for loopholes to avoid paying benefits rather than opportunities for you to get the most out of your claim. If you need Social Security disability benefits, hire a lawyer that wants to help you, not the insurance company.
Most disability insurance policies that are offered as a benefit to employment are subject to federal regulation under the Employment Retirement Income Security Act, or ERISA. Before ERISA, a claimant could have their appeal heard in state court by a jury of their peers. Now, a judge reviews the case in his or her office, only to decide whether or not the insurance company's decision was according to the terms of the policy. They use no moral judgement to make their decision about your benefits; they only take into account the confusing language that exists in the fine print, which you probably didn't read or understand when signing up for the policy.
The requirements and procedure for filing for long term disability insurance benefits is not designed to help you. In fact, the insurance companies sometimes use confusing language to make it next to impossible for you to see benefits that match the amount you've invested in the policy. It is a difficult and frustrating situation to find yourself in an insurance dispute while you're trying to recover from a disability and get back to work. You're not alone if you don't get benefits you paid for: you can appeal the decision.
If you are having trouble getting benefits under a disability insurance policy, your best bet is to call a lawyer. An attorney can help you understand your rights, your policy, the disability insurance claims process, and how to resolve the situation while minimizing your stress. I want to help you get the most out of your insurance policy. It is difficult to learn that your claim has been denied or diminished. Don't settle for limited, slow, or denied disability benefits. Call our offices today to discuss your claim in a free consultation with an experienced disability advocate.