The only guarantee that we have in life is that it is unexpected. You can feel invincible one day and then feel your body break down the following year. You and your family should not have to suffer financially because of unforeseen circumstances in life. If you happen to suffer from a temporary or permanent disability, you and your family still deserve to have financial support put in place to cover your household.
Even more importantly, you should know that your disability claim will be approved when you file for disability benefits. If your disability claim has received a denial, you deserve to have an experienced disability lawyer to help represent you in your appeals process.
Speak to a Baton Rouge disability claims attorney from J. Price McNamara ERISA Insurance Claim Attorney today.
When people think of benefits for disabled individuals, Social Security disability benefits often come to mind. While this is the most known type of disability insurance, you may exercise other disability insurance options. You can purchase disability insurance through your employer or private insurance companies that can provide financial assistance when you suffer from different types of disabilities and health conditions.
Disability insurance is an insurance policy that offers financial compensation to individuals whose disability compromises their ability to work. While there are some accidents that you can recover from, there are accidents that can cause you to become temporarily or even permanently disabled.
Even if you recover from an injury, the road to rehabilitation can require you to take time off for months following a medical procedure. In either case, disability insurance can help protect you and your family from any financial losses you can endure when you cannot work due to your disability.
Disability insurance policies come in two forms. One of the most common forms is short-term disability insurance. Short-term disability insurance provides coverage for individuals who are required to take time off from work for a short amount of time. If your disability requires you to take time off from a few weeks to a year, this disability insurance will benefit you. Some of the disabilities covered through this insurance policy include mental health disorders, musculoskeletal disorders, and pregnancies.
For your short-term disability benefits to kick in, you must file a claim with the insurance company that explains your disability in more detail. Each insurance plan has a different definition of disability that your medical condition must qualify for.
When your disability qualifies under the insurance policy’s definition, you must also follow a waiting period where you cannot work before the benefits can apply. Each waiting period for each insurance policy is different. However, the average waiting period ranges from 30 days to 12 months.
If your disabilities are more permanent, you can seek coverage through long-term disability insurance. Long-term disability insurance provides coverage for long-term or lifelong health conditions that will take you out of work for longer. Some health conditions covered through long-term disability insurance involve cancer, lupus, chronic fatigue syndrome, and multiple sclerosis.
To qualify for long-term disability benefits, the insurance company’s definition of a disability must include your specific condition. Every insurance plan has a different definition of what medical conditions fall under the definition of a disability. If your medical condition qualifies as a disability, you can file a claim with the insurance company. There is a required waiting period that you must follow before your long-term disability benefits can kick in. For most long-term disability insurance plans, the waiting period ranges from 90 to 180 days.
Many workers enjoy short-term and long-term disability insurance for several reasons. One of the reasons is that a broader range of medical conditions can have coverage through these insurance policies. Other benefits packages like workers’ compensation provide limited benefits and cover only workplace accidents.
Short-term and long-term disability insurance policies cover medical conditions like pregnancy and overexertion injuries that workers are more often to experience instead of more serious injuries. Even more permanent injuries can have coverage through long-term disability insurance.
Another reason many workers love disability insurance is that it provides more coverage than other benefits packages. Short-term disability insurance provides financial compensation that ranges from 40 to 70 percent of a worker’s base salary. Injured workers can receive this financial compensation for a few months to a year. The same type of compensation is covered through long-term disability insurance but for a longer period. Injured workers with long-term disability insurance can continue receiving 40 to 70 percent of their income until retirement.
To start the process of receiving your disability benefits, you will be responsible for submitting a claim to the insurance company. In this claim, you will have to explain in detail the nature of your disability and how it prevents you from working.
Your employer will also be responsible for filling out their portion of the claim. In addition to your employer’s information, you will also need to provide medical evidence of your disability. You can include this information through a copy of your medical records or medical notes submitted by your physician. Before submitting your claim, you also want to keep a copy of the completed form in case the insurer denies your claim.
While the insurance companies can approve your disability claims, they also can deny your disability claim for various reasons. Some of the common reasons why insurance companies deny disability claims include a lack of credible medical evidence, failing to qualify for the definition of a disability, missing the deadline to file, the disability is due to a pre-existing condition, and more.
If the insurance company does not consider the medical evidence presented as credible enough to prove your disability, they can deny your disability claim. Insurance companies may request to see evidence of routine physician visits or copies of medical test results.
Each insurance policy contains a strict definition of what is considered a disability. Depending on the type of insurance coverage, insurance companies use specific phrases to deny coverage for certain disabilities. For example, some long-term disability insurance plans define a disability as a disability that prevents you from working “any occupation.” That means you will have to prove that you cannot perform the duties of any job to qualify for disability benefits.
Each insurance plan also has a specific deadline that you must follow for your claim to be valid. When you file your claim past the deadline, insurance companies can easily deny your claim through this clause.
Short-term and long-term disability insurance plans have certain clauses that prevent you from receiving compensation for disabilities that result from pre-existing conditions. One of the clauses includes the “pre-existing condition exclusion clause,” which allows insurance companies to deny a claim for disabilities that can stem from any pre-existing conditions that you may have.
It can be devastating to receive a denial for your disability claim. However, it is quite common. No matter how insurance companies pretend to be empathetic, they are still a business at the end of the day. Their interest lies in not paying out as many claims as possible. Fortunately, you have the option of filing an appeal of the insurance company’s decision. Unfortunately, the process of filing an appeal depends on whether your employer provides your disability insurance or not.
If you purchased your disability insurance with a private insurance company, you must follow your state’s protocols to file a lawsuit against the insurance company. If you purchased your disability coverage through your employer, a federal law known as the ERISA Act (Employee Retirement Income Security Act) governs your insurance policy. ERISA is a form of federal legislation that protects employees’ benefits packages from deliberate mismanagement and abuse. Because many employers must follow the laws set in place by ERISA, you must follow a strict set of protocols when pursuing your appeal.
Under the ERISA appeals process, you must file an appeal with the insurance company within 180 days. One of the strict aspects of the ERISA appeals process is that you cannot file a lawsuit against the insurance company until you have exhausted all of your appeals.
Another strict aspect of the process is that the type of evidence that you are allowed to present is limited. During your 180-day deadline, you must gather a balance of evidence to build the best case for you in your administrative record. The only evidence that you can present in the appeals process is the only evidence that you include in your administrative record.
Even if your appeals process transitions to a lawsuit with the insurance company, you will not be allowed to include new evidence in your lawsuit. In your lawsuit, a federal judge will need to review your administrative record. You cannot testify on your behalf. The federal judge will only consider your administrative record when deciding to overturn the insurance company’s decision.
When your insurance company denies your disability claim, you deserve to fight to have that decision overturned, especially if there is no legitimate reason for your insurance company to deny your claim. However, because of its strict nature, you may be nervous about going through the ERISA appeals process.
At J. Price McNamara ERISA Insurance Claim Attorney, our Baton Rouge disability lawyers have the experience and passion necessary to help fight for your disability benefits. Here are some ways our disability lawyers can help you receive the decision you want for your disability claim.
Part of the uncertain feeling that you may be experiencing is fear of the unknown. Even though the process is strict, our Baton Rouge disability lawyers have experience in handling ERISA appeals. We can provide some clarity to the ERISA appeals process and help guide you on the best way to build a credible case for you.
Another benefit our disability lawyers bring to the table is the ability to gather the right evidence for your administrative record. Because everything rides on your administrative record, you do not want to leave the information collected up to chance.
Our Baton Rouge disability lawyers can ensure that not only is the best evidence presented in your administrative record but that there is a balance of every type of evidence presented in your administrative record. Your disability lawyer can request a copy of your disability claim, assess why your claim was denied, and decide on the best types of evidence that can refute the insurance company’s decision.
When deciding on the disability lawyer you want to represent you, you want to consider the fruit on the tree.
At J. Price McNamara ERISA Insurance Claim Attorney, our law firm has a proven track record of reaching successful settlements and verdicts with ERISA-sponsored disability claims. One of our most successful verdicts includes a $1,300,000 trial verdict that concerned the denial of an ERISA-sponsored accidental death and dismemberment claim.
Filing a successful disability claim is a complicated and challenging process. Further, receiving a denial of your disability claim can be devastating. Although you might need to fight for benefits, you do not have to do so alone. The right legal team can help with your claim or appeal.
Allow the Baton Rouge disability lawyers to help increase your chances of success in your fight. Call our office at (225) 201-8311 or submit our contact form for a consultation with a Baton Rouge disability claims attorney.
10455 Jefferson Hwy,
Baton Rouge, LA 70809
Fax: (225) 201-8313
“Price is very professional, honest, and reliable. Whatever he says, he will follow through with the utmost integrity. He will turn over every stone and pays close attention to even the smallest detail.”
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts