Aflac sells itself as a company that you can trust when you are in a time of need. They sell supplemental insurance policies to cover many areas. You may have purchased Aflac short-term disability coverage on your own, or the company may be the carrier with which your employer works.
Either way, you cannot expect an easy process when applying for the short-term disability benefits you both expect and need. You may even need to hire an attorney to fight for what you deserve.
An experienced disability attorney knows the tactics insurance companies like Aflac use to deny or reduce benefits to disabled claimants. If you need to file a claim, are experiencing delays, or received a denial, immediately seek representation from an Aflac disability claims lawyer.
Aflac Is Nowhere Near as Ethical as It Claims
For years, Aflac presented itself as one of the world’s most ethical companies. In 2018, a whistleblower pulled the curtain back on some of the internal happenings at the company.
While none of these allegations directly centered on disability insurance policies, the same company that asked employees to manipulate key operational metrics to look better to shareholders is the same business policyholders must trust to do right when they are in a difficult financial position. You cannot ensure that Aflac representatives will provide your rightful benefits without the right legal help.
Catchy Commercials Mean Nothing in Your Time of Need
Aflac is like any other company that provides short-term disability benefits. No matter how amusing their commercials are or who they pay to be their spokesperson, the company is less than charitable or friendly when you have actually filed a claim.
Aflac does the same as every other company that provides long-term disability insurance. They know that the law is on their side. Thus, they will deny claims and ask questions later. Your only option is to file an appeal so you can get objective consideration of your claim by a federal court when the insurance company says no.
Aflac Often Leaves its Policyholders High and Dry
When you need them the most, Aflac may not be there for you. Know that you have legal recourse and the ability to fight back. The best way to counter the insurance company is to hire an experienced attorney to fight them. Otherwise, they may uphold a wrongful denial and get away with it.
Aflac does not necessarily have the best record of doing right by people who have trusted them and filed claims. The company routinely finds itself in litigation when they have unfairly denied benefits.
If you fall into this category, you can challenge Aflac’s decision. First, hire an experienced disability attorney to take your case forward.
How Short-Term Disability Should Work
Your short-term disability insurance policy can pay you a percentage of your earnings before you became ill. Depending on your policy, this percentage can be between 40 to 70 percent.
In most cases, you can get these benefits for around six months before you begin your claim for long-term insurance benefits, as short-term disability benefits generally last up to one year. Have your lawyer start the long-term benefits process to avoid gaps in coverage.
Common reasons why you might need to file a short-term disability claim include:
- You were out on maternity leave
- You needed treatment for a condition like cancer, after which you can return to work
- You are dealing with a debilitating back injury
- Mental health issues are keeping you from working
Aflac May Claim that You Do Not Have a Disability
Your disability insurance policy contains a definition of disabled. Generally, this definition is some statement that you cannot work. For short-term policies, this definition covers the fact that you cannot perform the duties of your job. The company often claims you can work in the face of evidence to the contrary, especially knowing ERISA allows them to get away with a lot.
Aflac often sharpens their pencil and tries to find any way possible to deny your claim. One of their favorite tricks is automatically denying any type of claim without voluminous objective medical testing to support your case.
This approach almost automatically rules out benefits for things like mental health issues. If they cannot see it conclusively on paper, they are definitely not going to take your word for it.
Why an Insurance Company May Deny Your Claim
Here are some common reasons why Aflac may deny your short-term disability claim:
- The weight of the medical evidence does not support your disability
- You failed to follow the medical treatment recommended for you
- The insurance company conducted surveillance on you, and they do not believe that you are disabled
- Your policy excludes coverage for a preexisting condition, and the insurance company believes that your condition falls into that category
- You missed certain deadlines specified in your policy
- The claim is missing information
When you receive a denial, the letter should clearly state the basis. You should immediately consult a disability lawyer who can review whether the denial was wrongful and your next options.
You Can Take Legal Action Against Aflac
Aflac is not always right when it denies your claim. Chances are that the company is looking out for its own financial interests at the expense of yours. The company may hide behind complex legal language in the hopes that you will go away completely. When you hire an experienced Aflac disability insurance attorney, you can become Aflac’s worst nightmare.
It does not matter that Aflac is a massive company (the company has a market capitalization of nearly $50 billion). You can become a thorn in their side that will not go away when you hire an aggressive and experienced lawyer.
If the facts and law are on your side, Aflac’s massive size will not help them. Aflac may have resources and unlimited money, but nothing says that they want to spend that money to fight you. They may just want to increase their own leverage by denying your claim.
You Can Sue Aflac Directly if You Bought Your Own Policy
If your Aflac disability policy was self-purchased, different rules apply to any disputes. Your short-term disability policy will be a private contract between you and the insurance company. You are in a stronger legal position than if your company purchased the policy for you. The procedure works in your favor much better than in cases involving employee benefits plans.
You will sue the insurance company under state law. You can file the lawsuit directly without going through the insurance company appeals process first. The court will consider the language of the policy and your own specific situation in determining the outcome of your case.
When you can sue the insurance company directly, you may even claim them for bad faith if they intentionally mishandled or wrongfully denied your claim. In bad-faith claims, your lawyer might seek punitive damages if the insurance company’s conduct was egregious enough.
Each party to a contract must act in good faith, and denying your claim without any valid basis may be bad faith. You can end up with even more money in a bad-faith lawsuit.
Appealing Your Claim Denial Under ERISA
If your Aflac policy came from your job, an entirely different set of rules apply. Here, a federal law called ERISA comes into play. ERISA takes an already difficult appeals process and makes it much harder. There is little recourse against the insurance company itself because ERISA does not allow you to sue for bad faith.
If your claim received a denial, you need to take some time to review the insurance company’s reason while you prepare your next steps. While you may be facing a lengthy appeals process, you also cannot afford to rush.
You could make a mistake or fail to include relevant information if you move too quickly. If you know why Aflac denied your claim, you can directly address the reasons in your next submission.
ERISA Procedures Can Be Tough, But You Can Win
ERISA gives the insurance company a huge advantage. If they deny your claim, you must file an appeal with the insurance company. The same company that denied your claim in the first place will likely dig in and just find a way to better document their own reasons for keeping you from the benefits that you need.
You have very little chance of winning the insurance company appeal. However, ERISA requires that you fully participate in the process. It gives the insurance company a built-in advantage.
What to Include in the File When Appealing Aflac’s Denial
The crucial importance of the insurance company appeals process is the appeal file that you need to build. The insurance company will consider the relevant information in rendering their decision.
Your appeal file can include:
- Objective test results that can show the extent of your condition
- A personal impact statement that describes how you have been affected by your condition
- Statements from friends and family who witness what you go through
- Testimony from vocational experts who can give their opinion of whether you can still do your job with your condition
You only have one chance to fully build your appeal file. Once the insurance company appeals process concludes, you cannot add anything to the file. The federal district court does not allow you to supplement the file except under very limited circumstances. In other words, you must speak now or forever hold your piece. Thus, you need an attorney at the beginning of the appeal process.
You Can Continue to Appeal in Federal Court
After you unsuccessfully go through the insurance company appeals process, you must take your case to federal court to continue your appeal. The judge will review the insurance company’s decision.
Depending on the language of your policy, the judge may need to give a certain level of reference to the insurance company’s decision. Nonetheless, a federal judge can and should overturn the insurance company’s decision when it is wrong.
The insurance company should not succeed in wrongfully denying you benefits, and an ERISA lawyer can fight back for you.
Strong Legal Representation Can Put You in a Better Position
Aflac has been known to go many rounds in court to deny you the necessary benefits. The only thing working in your favor is that Aflac is paying a defense attorney by the hour.
If your case involves short-term disability benefits, Aflac may find that it is more cost-effective to either grant your benefits or negotiate a settlement than it is to fight you to the end. It can cost Aflac more to defend against your lawsuit than it does to just pay you the benefits.
Therefore, it is at least worthwhile to hire an experienced attorney to put up a strong legal showing and indicate you are ready to go to court if necessary.
An ERISA disability insurance attorney works for you on a contingency basis. You do not need to pay your attorney anything upfront. You only pay them if your case is successful and you receive either benefits or a settlement. If you do not win, you do not pay.
Given the high potential for litigation, you must hire an experienced Aflac disability insurance attorney. There is no risk to you when you hire a lawyer. On the other hand, you can pay a price if you do not get legal representation because it is almost impossible to win your case following a denial.
Protect yourself from wrongful denials of Aflac benefits. Consult an experienced ERISA attorney immediately for assistance with your claim or appeal.
J. Price McNamara
Attorney
Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!
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