If it is one thing that the past few years have revealed to us, it’s that life is unpredictable. Life as you know it can change in the blink of an eye. Yet, some of us don’t have a plan in case our ability to work has been affected. While most workers rely on workers’ compensation insurance to cover their injuries, other insurance policies can offer workers more coverage for a broader range of medical conditions.
A Baton Rouge disability appeal attorney from J. Price McNamara ERISA Insurance Claim Attorney can assist with your claim. Our legal team has been helping clients with disabilities and other conditions since 1995, and we pride ourselves on the results we obtain. If you need assistance with a denied claim, reach out and speak with our legal team today.
Table of Contents
- Basics of disability insurance
- How disability insurance helps workers
- What are the different types of disability insurance?
- What medical conditions does disability insurance cover?
- What insurance companies will we take on?
- Contact a Baton Rouge disability appeal attorney today
Basics of disability insurance
One of those insurance policies that workers can obtain from their employers is disability insurance. Disability insurance provides financial coverage for injured workers who cannot work. Through disability insurance, you have income protection that can range from three months to your retirement age, depending on the type of insurance policy you purchase. The benefits that you receive from your disability insurance policy can go towards your financial expenses while you recover.
How disability insurance helps workers?
Disability benefits can help workers during their most vulnerable times. Whether workers suffered an injury at or outside the workplace, the fear of wondering how monthly expenses will be covered runs through their minds. Workers can even find themselves in tough predicaments like returning to work before recovering from injuries.
Disability insurance is like a safety net that can benefit each worker. Injured or sick workers get a sense of peace when they know that disability insurance will cover their financial obligations as they focus on healing.
What are the different types of disability insurance?
Disability insurance often comes in two types: short-term and long-term. Short-term disability insurance is an excellent policy for workers whose injuries are not as permanent and require workers to undergo medical treatment like surgery or rehabilitation. Long-term disability insurance is an excellent policy for workers whose injuries are long-lasting. Workers can choose to purchase one or both of these policies. Workers possessing both these insurance policies receive full coverage for their injuries.
What medical conditions does disability insurance cover?
One reason disability insurance is so popular among employees is that it can offer financial coverage for most medical conditions. The only injuries covered through workers’ compensation insurance are the injuries that workers obtain from job-related accidents. Workers who suffer an illness or injury can still receive benefits for their medical conditions, whether their injuries resulted from work or not.
Some of the medical conditions covered through disability insurance include:
- Joint disorders
- Carpal tunnel syndrome
- Dementia
- Allergic reactions
- Mental disorders
- Loss of speech
- Cardiovascular conditions
- Autoimmune disorders
- Chronic skin disorders
- Cancer
What medical conditions doesn’t disability insurance cover?
Even though disability insurance covers most medical conditions, every policy contains exclusions. Many disability insurance policies exclude medical conditions caused by a pre-existing condition.
Other exclusions from many disability insurance policies include:
- Suicide attempts
- Disabilities caused by substance abuse issues
- Disabilities that stemmed from a workplace accident
Worker’s compensation must cover any injuries that happened at the workplace.
Common medical conditions used for short-term disability claims
Some of the common medical conditions used to file a short-term disability claim include:
- Maternity leave
- An injury that occurs from a major accident
- Pregnancies (C-sections)
- Musculoskeletal conditions
- Hearing loss
- Back problems
Common medical conditions used for long-term disability claims
While short-term disability insurance can cover temporary medical conditions, long-term disability insurance provides coverage for more permanent medical conditions.
Some of the common medical conditions long-term disability insurance policies cover include:
- Breast cancer
- Multiple sclerosis
- Epilepsy
- Post-traumatic stress disorder
- Asthma
- Depression
- Stroke
- Lupus
- Migraines
- Heart disease
What if your employer sponsors your disability insurance?
You can purchase disability insurance through several channels. Major insurance companies like MetLife, Northwestern Mutual, Mutual of Omaha Bank, and Guardian provide individual long-term disability insurance plans. You can also purchase a long-term disability insurance plan through your employer.
Some benefits and challenges come with each type of plan, but the kind of disability insurance plan you buy will have significant legal consequences for you moving forward. For example, if you purchase long-term disability insurance through your employer, your insurance plan will most likely include group coverage and be covered through ERISA.
The Employee Retirement Income Security Act (ERISA)
The Employee Retirement Income Security Act (ERISA) is a federal law that provides federal protection to employees’ benefit plans. The federal law not only governs how employers offer benefit plans to their employees but provide federal rights to employees against abuse and wrongdoing against their benefit plans.
One of those rights involves the right to sue an insurance company if it mismanaged or failed to pay an employee's benefits. That means that when an insurance company denies your disability claim, you must follow federal procedures under ERISA.
What happens if your disability claim gets denied?
When you have a short-term or long-term disability insurance policy, you begin obtaining your benefits when you file a claim with the insurance company. Each insurance policy will contain instructions for the policyholder to follow when submitting a claim.
Generally, both insurance policies will request medical documentation explaining the severity of the worker’s injury or illness and the restrictions associated with that illness or injury. Insurance companies will deny your disability claim for various reasons and explain the appeals process you must follow if you want the denial reversed.
ERISA appeal process
When purchasing disability insurance through your employer, you must follow the ERISA appeal process with your disability claim.
The ERISA appeal process involves:
- Filing an administrative appeal with the insurance company within 180 days of receiving a denial letter
- Exhausting all administrative appeals with the insurance company
- Filing a federal lawsuit against the insurance company once the administrative appeals are exhausted.
If the process sounds lengthy, that is because it can be. The deadline to file an administrative appeal with the insurance company takes at least six months. The insurance company also has a deadline of 45 days to respond to your administrative appeal. If the insurance company feels you need to submit additional information about your appeal, the 45-day deadline can increase by 45 days.
How insurance companies use the ERISA appeal process to their advantage
Specific steps in the ERISA appeal process give insurance companies an advantage. One of the steps involves the requirement to exhaust all administrative appeals before even being allowed to file a federal lawsuit. Insurance companies have the power to drag the administrative appeal out by requesting that you submit additional information about your claim. Insurance companies also receive protection through the ERISA appeal process.
Because you can only file a federal lawsuit for your disability benefits, you cannot file a lawsuit against the insurance company for other damages like bad faith practices and a breach of contract. Insurance companies can practice as many unethical actions as possible against you throughout the appeal process without suffering federal consequences.
One appeal
One of the most stressful factors about the ERISA appeal process is that you only have one shot at an appeal with the insurance company. Because the appeal process is already time-consuming, it can be devastating to hear another denial of your disability claim. However, the actions taken to submit the administrative appeal are vital because they can affect the outcome of your federal lawsuit moving forward. The information you present in your administrative record is the only information the judge will see at trial.
Mistakes that often cost claimants in an ERISA disability appeal
Because there is so much at stake, it is common for claimants to make mistakes when filing their administrative appeals.
Some of the common mistakes that claimants often make include:
- Missing the deadline. When claimants miss the deadline to file their administrative appeal, that is it. They permanently lose their chance to convince an evaluator to overturn the insurance company’s decision.
- Failing to submit a complete administrative record of their claim. The administrative record is the only time claimants can submit new evidence to the appeal for consideration. Afterward, new evidence will not be presented, even at their federal trial.
- Failing to submit new information that you can include in a federal lawsuit. The administrative record is essential for several reasons. Claimants not only submit evidence for their administrative appeal but their federal lawsuit. They require credible evidence that fact-finders at every level cannot deny.
Why you need a Baton Rouge disability appeal attorney
Even if it sounds like the odds are not in your favor with an ERISA appeal process, you have the right to fight for your disability benefits. If your disability claim is legitimate and valid, the insurance company must be held accountable for preventing you and your family from receiving the benefits you deserve.
Because the ERISA appeal process is complex, you need an experienced Baton Rouge disability appeal attorney on your side who can increase your chances of having your denial overturned.
How to proceed with insurance companies
At any point, the insurance company can request that you submit additional information with your administrative appeal. Some of these demands can be reasonable, but the insurance company often makes this request when there is doubt about the severity of your disability. The insurance company can also make this request as a way to use your evidence and words against you.
An experienced disability appeal attorney can provide the best legal advice on how to handle the insurance company's request.
Provide the best types of evidence for your administrative record
Another benefit that a disability appeal attorney brings to the table is the ability to present the best case through your administrative record. The success of your ERISA appeal process depends on the strength of the documents you present in your record. An experienced disability appeal attorney can strengthen the claims made in your administrative record through a legal brief alone. Your disability appeal attorney can also provide strong evidence like plan documents and medical evidence.
Obtain evidence that can challenge the insurance company’s decision
An experienced disability appeal attorney knows the proper evidence to include in the administrative record. Disability appeal attorneys have enough experience with ERISA laws to determine the appropriate type of evidence that can challenge the insurance company’s decision.
Based on your claim’s legitimacy, it can be easy to introduce the right type of evidence to call the insurance company’s reasoning into question. Your disability appeal attorney can find fault with the insurance company’s decision to deny your disability claim and present that evidence in the most professional way possible.
What insurance companies will we take on?
At J. Price McNamara ERISA Insurance Claim Attorney, our disability appeal attorneys are not afraid to take on major insurance companies. We separate ourselves from other attorneys by taking these insurance companies head-on.
Some of the insurance companies that we don’t mind taking on include:
- Northwestern Mutual
- Assurity
- MassMutual
- Mutual of Omaha Bank
- Unum
- Ameritas
- State Farm
Contact a Baton Rouge disability appeal attorney today
When you want to fight for your disability benefits, you deserve to have quality legal representation on your side.
The disability appeal lawyer at J. Price McNamara ERISA Insurance Claim Attorney can evaluate your disability policy and create the best strategy possible against the insurance company.
Call our firm today at (225) 201-8311 or complete our contact form for your Free Denial Review. A Baton Rouge disability appeal attorney can answer all of your questions, provide you with an honest assessment of your claim, and guide you in the right direction.
Baton Rouge Office
10455 Jefferson Hwy,
Suite 2B
Baton Rouge, LA 70809
Phone: 225-425-7917
Fax: (225) 201-8313
(By Appointment)
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