For those suffering from a long-term disability, it can be frustrating to learn that after years of dutifully paying premiums for a long-term disability plan, the insurance company is denying the claim. An unjust and unfair long-term disability (long-term disability) insurance denial can spell financial disaster for a family, especially when the person suffering from a disability is the primary breadwinner.
If you have been told you are not going to receive long-term disability benefits through an employer-sponsored plan, do not lose hope. Talk to an experienced long-term disability benefits lawyer from the Law Offices of J. Price McNamara. You have paid for the benefits; do not let the insurance company decide your rights without speaking to an attorney first. Keep in mind that appeals deadlines can be as short as 60 days, so call right away.
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal statutory scheme that protects employers from unscrupulous insurance companies and employer-sponsored benefit plans. Under the law, employers must take measures to be careful with employee funds. Many employers will outsource this task to a third-party administrator (TPA). These employers and TPAs often become overly conservative with funds, outright denying even the most valid and deserving claims. This too, however, is inappropriate. You can be denied a claim for long-term disability for two broad reasons:
If the insurance company denies your claim for long-term disability benefits on technical grounds, it likely means one of the following:
The vast majority of initial denials are made for technical reasons. If this happens, the solution may be straightforward. For instance, if you are denied because you applied for long-term disability benefits too soon, an experienced attorney can help guide you through the process of timing applications and potential appeals to help expedite the process and avoid further delays.
If the insurance company makes a substantive denial, it likely means the evidence you submitted does not meet the insurance company’s definition of a disability. While the term “disability” may seem obvious, your insurance policy will have specific rules and guidelines for what qualifies as a disability under your plan.
Typically, disability is defined as a permanent or long-term injury or illness that prevents you from being able to work and which is anticipated to continue preventing you from working for longer than the waiting period. You may think it is obvious that your condition prevents you from working or that it is a permanent condition, but it may be necessary to present evidence from specialists that will clearly outline how and why you are prevented from working.
If you have been unfairly denied long-term disability insurance coverage, you can not afford to wait too long. Often you will need to exhaust all of your options under the insurance policy before you can sue the insurance company for your hard-earned benefits. Appeals deadlines can be as short as 60 days, so call the Law Offices of J. Price McNamara today to schedule a completely free consultation with a Metairie Terrace Long-Term Disability Benefit Lawyer near you.
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