Experienced Philadelphia Private Disability Attorneys Can Assist with All Aspects of Your Denied Insurance Claim and Appeal
A disability insurance company’s decision to deny your claim can be traumatizing and infuriating. You may have paid thousands of dollars for disability insurance coverage just to have your insurer refuse to accept liability for your claim. You may have met your contractual burden of proving disability only to have your claim rejected. You are simply seeking to claim a benefit for which you applied and paid premiums. Fortunately, a Philadelphia disability insurance claim lawyer can assist you in recovering the financial relief you are entitled to by appealing the insurance company’s denial of your claim.
You should be aware that a claim denial does not mean that you will be permanently excluded from recovering disability insurance benefits under your policy. When you consult with the Philadelphia private disability insurance lawyers at our firm, we will fully evaluate your circumstances and explain any rights you have to remedy your claim. We can address any deficiencies in your claim and misconduct by the insurance company while appealing the disability insurance claim denial.
Understanding Why Your Individual Disability Benefits Were Denied
Insurance companies are for-profit businesses with a goal of maximizing profits by limiting liability. Claim denials allow insurers to avoid liability for the streams of benefit payments that a claimant may be due. Disability insurance companies rely on many insureds to simply walk away from their claims upon receipt of a denial letter. If your claim was denied, your disability insurance company is likely hoping you do the same. This is particularly true when the insurance company is evaluating claims for disability insurance benefits made by high-income individuals such as doctors, dentists, lawyers, and other professionals. If a high-earning claimant simply walks away from their claim for disability insurance benefits at the first denial without appealing the determination, the insurance company will escape liability and boost its bottom line at your expense.
As such, it is important that you act promptly to understand the basis of the insurance company’s denial. When a disability insurance provider denies a claim for disability insurance benefits, it is required to provide a reasonable explanation for its determination. If your insurance company failed to provide a reasonable explanation for the claim denial, it may be in violation of state insurance regulations.
The company’s position letter is important because many claim denials result from a claimant’s arguable failure to provide sufficient documentation to support the claim, or the misapplication of policy terms by the insurer. At Seltzer & Associates, our Philadelphia private disability insurance lawyers begin the review process by analyzing the disability insurance policy and denial letter. We will thoroughly assess the information that the insurance company relied upon to deny liability.
We will establish a detailed plan coordinated with our clients while working to substantiate the claim and overturn the insurer’s adverse decision. We will also analyze and draw attention to any deficiencies in the company’s claim investigation and check for any bad faith activity. Upon completion of this review, we present our clients with any options available to proceed with on their behalf, including submitting a voluntary or mandatory appeal, engaging in pre-suit mediation or litigation. We effort to shift the burden back on to the insurance company, and work with you to obtain the disability insurance benefits needed to sustain you during time of illness or injury. Through our advocacy, we strive to make a difficult and complex process easier for our clients.
Occupational Issues and Your Denial of Disability Insurance Benefits
Disability insurance companies can deny a claim for disability insurance benefits based on occupational factors. Many disability insurance policies provide coverage if the insured is disabled and unable to engage in gainful work in any occupation. In this situation, highly trained and skilled workers can be denied disability insurance benefits if the insurance company and their vocational experts deem the insured to be able to work at some level, even if the job is lower paying and does not utilize the claimant’s education, training and expertise. For this reason, many skilled professionals, such as surgeons and physicians, will seek a disability insurance policy that offers coverage if the insured becomes disabled and unable to work in their own occupation. The Own Occupation analysis considers the specific requirements of the occupation you were performing at the time of disability, though coverage is often limited to a certain period of time, often two years or less. You will need to present evidence of your occupational duties and the restrictions or limitations due to your disability that prevent you from completing the required tasks. If you have an Own Occupation disability insurance policy, and you are denied disability insurance benefits, a Philadelphia disability insurance claim lawyer will know how to appeal this decision and present evidence to your insurance company for proper consideration of your claim.
Another concern for disabled claimants is navigating partial disability or residual disability claim status. For example, your treating physician may release you back to work in a limited capacity, or your medical condition may prevent you from completing some but not all of the material duties of an occupation. Working in a limited capacity may result in an income shortfall, which disability insurance benefits could supplement. While your policy may include residual or partial disability provisions, the disability insurance company could still dispute your limited work capacity. Many disability insurance policies do not provide partial disability insurance benefits – you may need to include this as coverage Rider at the time you purchase your policy. These policies need to be examined carefully so that you understand the requirements for eligibility and your rights to appeal if denied.
Seltzer & Associates has experience representing highly-trained and skilled professionals nationwide pursuing disability insurance benefits, including handling appeals for denied or terminated claimants with individual disability and ERISA-governed group claims. We can understand your concerns and the challenges specific to disability insurance claims made by professionals.
Your disability insurance benefits may be denied based on incorrect vocational analyses. You should have accurate job descriptions for any pre- and post-disability work activity. You can expect the insurance company to thoroughly analyze and question you regarding your work history and to engage vocational experts to examine your vocational background. Seltzer & Associates will address any mischaracterizations of your occupational demands and work activity to ensure that your occupation is appropriately identified and its demands are not minimized.
The Appeals Process for Individual Disability Insurance Claims
A voluntary appeal is a time-consuming but cost-effective way to overturn your individual disability insurance claim denial. Unlike ERISA governed claims, which require the submission of an appeal, most individual disability insurance companies offer claimants a voluntary appeal process rather than compelling immediate litigation. Even if the denial letter does not specifically address the terms of an appeal or request for reconsideration, our law firm will communicate directly with the insurance company regarding remedies available to you. Resolving your claim through a voluntary appeal rather than compelling litigation can generate a favorable outcome for our clients in less time and at a lower cost than during the litigation process.
Individual disability claims are complicated, and claimants are easily overwhelmed when trying to satisfy the requirements for eligibility.
It is important that you continue to seek appropriate medical care for your disabling condition. Evidence of ongoing disability is an important component to filing a successful appeal and reversing a denial of your claim for disability insurance benefits. Conversely, failing to receive appropriate care for your condition can be cited as a reason your claim is denied. If you have questions about a denial, either wholly or partially, on this basis, you need to discuss this with an experienced Philadelphia disability insurance claim lawyer.
Most claimants are unaware that disability insurance companies employ teams of in-house medical, occupational, vocational and financial consultants to participate in claim reviews. These consultants are generally experienced insurance company employees looking to exploit any deficiencies in the information provided by a claimant to the insurance company. Claimants should be wary of the tactics employed by these internal consultants who can be expected to act in the best interest of their employer. These internal consultants will focus their efforts on providing the insurance company with a basis to deny or terminate a disability insurance claim even in cases where there may be substantial supportive evidence of the claimant’s ongoing disability. Just as insurance companies have teams of experts standing by to refute your disability claim, you should have the professional and experienced support of a Philadelphia disability insurance claim lawyer. You can depend on Seltzer & Associates to handle your denial or termination of benefits and file an appeal on your behalf.
The appeal process should be seized as an opportunity to supplement the insurance company’s claim file, and to put the disability insurance company on notice of the issues that will be litigated should it fail to reverse an unreasonable denial or termination. We will specify any deficiencies in the company’s review, including any contractual or legal issues relevant to a disability claim. Upon submission of the appeal, we engage in an open dialogue with the company to help expedite its review and obtain the most favorable result for our clients.
Mediation for Individual Disability Insurance Denials
Mediation may be another option we can pursue on our clients behalf to resolve a claim without filing a lawsuit. Mediation may be appropriate when stipulated in a policy, when furthering the appeal process is unwarranted or when the company’s adverse decision has been upheld. Mediation consists of both parties presenting their positions before a mediator, a neutral third party. We carefully screen and select all potential mediators to ensure they have the knowledge and experience to provide a full and fair review of our client’s claim. Even after filing a lawsuit and commencing litigation, there will be an opportunity to enter mediation. This can come by agreement among thel parties or at the direction of the presiding judge.
At mediation, we will address any issues with respect to disability claim and policy with the goal of obtaining a favorable resolution for our client prior to filing a lawsuit. Mediation is an opportunity to explain and support the presence of your disabling condition and the limitations preventing you from returning to work in your pre-disability capacity. Disability insurance claims are not one-size-fits-all, even if the insurance company sees numerous claims a year for similar conditions or professions. It may be best to present your unique circumstances and the merits of your claim to a neutral, mutually agreed-upon mediator.
Whether mediation resolves your conflict or you need to proceed to court, our Philadelphia private disability insurance lawyers will be available for you every step of the way. Begin the process of having your disability insurance claim reviewed today by scheduling your free consultation.