Millions of Americans become disabled every year. We can help.
Use privacy settings on your Social Media accounts and other online forums. Insurance companies monitor
Facebook and other online accounts to and information about your activities. They use activity found there to argue you are not disabled and should be able to work. Avoid having to explain your posts by minimizing your use of Social Media and using privacy settings.
Document ALL communications with the insurance company, including ANY phone calls. Send follow-ups in writing. Ask for and use the email address of your claims adjuster. DO NOT assume the insurance company is your friend, or that any tape recordings made by the
insurance company will be discoverable at a later date. Know your rights in the State of Arizona for communicating with them and protect yourself.
What to Know Before Submitting STD or LTD Insurance Claims
Every Policy Is Unique
We often explain to clients that each short term and long term disability policy is like a snow‑flake, meaning that disability benefits are uniquely denied by specific terms and provisions the insurance carrier included in your individual policy or group plan. Unlike Social Security Disability Insurance, where Disability is denied by a national statute, no common definition of Disability is required for employer-provided (group policies) or personally-funded disability benefits (individual policies).
How We Help:
Our attorneys focus exclusively on disability benefits law. We are the best resource for reviewing your STD or LTD insurance policy to ensure complete understanding of your specific coverage, including what it means to be Disabled, and how to prevent potential pitfalls when submitting a disability claim.
You Can’t Rely on HR or Your Insurance Carrier
If ERISA law governs your benefits, deeper analysis is essential. We routinely speak with clients who believe they have the correct policy documents but all they really have is a summary plan description or employee handbook. Under ERISA, these documents are not always authoritative, and a written request for complete documents from the plan administrator is necessary to fully understand your coverage.
How We Help:
It is always helpful to have a disability benefits lawyer review your disability policy documents.
Many insurance carriers misrepresent coverage or ingenuous to the governing law around it. We frequently see insurance representatives cite the wrong policy provisions, provide incorrect coverage information, and even conceal the truth of a claimant’s coverage for their financial benefit. Often, employers and HR staff are not fully aware of their responsibilities under the law and unknowingly fail to provide complete disclosures or maintain required information.
It is staggering how often people think they have the right information, only to discover that their insurance company and/or their employer misinformed them about their coverage. <a id=”submit”></a>
Submitting Claims for Disability Income Insurance
Perhaps you are dealing with worsening medical conditions and wondering about the right time to leave work, or you have already left work and need help completing forms the insurance company is requesting you or your doctors to complete. No matter where you are in the process, consulting a disability lawyer early in the process is the best way to avoid problems down the road. Strategy is key when it comes to submitting a claim.
How We Help:
Our analysis will include determining the governing law, identifying missing policy documents, and advising you about your coverage. We also help you understand provisions, such as total versus residual disability assessment. Upon review, we can assist with submitting your short term or long term disability claim or manage your active claim to ensure your disability benefits are maintained.
We take care of fighting for you, so you can focus on what matters most—your health.
Common Reasons for Denials
We routinely see denials occur at the change in definition of Disability from Own Occupation to Any Occupation, or as a result of an insurance company alleging you are disabled based solely on a condition that is limited under the policy, such as a mental/nervous condition. Insurance companies also deny claims for lack of medical support or based on your doctor’s refusal or inability to complete forms.
Oftentimes, the insurance company denied your claim for reasons they do not clearly state in the denial letter they send you. In denying your claim, the insurance company likely engaged in procedural violations under ERISA or they committed Insurance Bad Faith.
To determine the extent of the insurance company’s bad faith or mismanagement of your claim, these are some key questions to consider:
- Are there undisclosed reasons for denial in the claim file, most likely to be found in their internal notes?
- Did the insurance company fail to consider information in support of your disability?
- Did the insurance company fail to have your treating providers respond to “independent” reviews?
- Did the insurance company fail to consider your Social Security Disability award?
- Did the insurance company fail to consider cognitive impairments in your ability to work?
- Did the insurance company fail to consider medication side effects?
- Did the insurance company fail to consider whether you can work continuously and consistently?
How We Help
While this list is by no means exhaustive, if the answer is “yes” to any of the above, you likely have a strong basis for an Appeal. Our experienced disability attorneys know what it takes to get the benefits you deserve. We file and fight appeals for you so you can focus on what matters most—your health. CTA button for Get Help Today?
Tactics Insurance Companies Use to Deny Benefits
Insurance Companies frequently invent evidence to support a denial of short term and long term benefits and find ways to misrepresent the reality of your medical conditions. Insurance companies commonly use the following tactics to deny STD and LTD claims:
- Independent Medical Examinations
- Functional Capacity Evaluations
- Attending Physicians’ Statements
- Vocational Reviews (also called Employability Assessment Reviews, or Transferable Skills Analyses)
- Nurse Case Manager or Physician File Reviews
- Surveillance or other “Special Investigation Unit” efforts, such as Social Media searches
- Lack of Medical Testing or Information
- Misrepresenting Medical Records, Discussions, etc.
- In-person Interviews
While the insurance company usually has the right to examine you and investigate your disability claim, you also have rights when it comes to your participation and consent, especially if it involves your safety or livelihood.
How We Help
If you have experienced any of the above or are about to attend an independent medical examination or interview, contact us without delay. You have the right to representation and should know your rights. An insurance company’s use of these tactics indicates eorts being taken to deny your claim. Be vigilant and call us to discuss your rights today.
Coping with disability is one of the most challenging and frightening experiences of your life. When dealing with a disability, it is dicult enough to take care of yourself, let alone ght a massive insurance company. Our goal is to take the burden of dealing with the insurance company o your shoulders, so you can focus on your health. We are highly experienced in handling insurance companies and know how to advocate for you.
Your Rights in Claim Denials
Many people do not understand their rights or just how important it is to send a written request for information, especially before submitting an appeal from a denial of benefits. Under State law (Bad Faith) and Federal law (ERISA), insurance companies and plan administrators must maintain claim file and policy documents and, in some cases, are required to provide copies for your review.
Under Arizona law, an insurer must provide you a complete copy of your policy. If denying a claim, the insurer must also provide a written denial that cites the specic policy provisions that were relied upon in denying the claim. To understand your rights and what disclosures are available to you under State law, contact us. You may also contact the Arizona Department of Insurance to report an insurer’s violation of Arizona law.
If your benefits are governed by ERISA, federal law preempts state law requirements and actually calls for more broad disclosure requirements. Under ERISA, if your claim has been denied in whole or in part, a plan administrator is required to provide you with a copy of all relevant documents free of charge. This is a very broad disclosure requirement, entitling you to more than just the medical records relevant to your claim. In our experience, insurance companies or plan administrators rarely comply with their disclosure obligations under ERISA. Again, requests for documents must be made in writing; a phone call is not enough to trigger disclosure obligations.
How We Help
We can explain your rights and help obtain all relevant documents. If it has been more than 30 days since you sent a written request, contact us for help immediately.
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