After sustaining an injury or being diagnosed with a condition that requires you to take an extended period of time off from your job, many workers in Texas have disability coverage through their employer. So long as they select the coverage and have paid the premiums with each and every paycheck they received, they typically have faith that their ERISA-based disability claim will be approved.
However, after weeks of waiting, you might receive a letter stating that your claim was denied, even though you obtained the necessary paperwork and medical documents to apply for your disability benefits. While this may be quite shocking, you do have several options that a qualified ERISA attorney could help you pursue. If your claim for benefits was denied, a Texas ERISA disability claim denial lawyer may be able to help you appeal that decision and get your claim approved.
Insurance companies benefit financially by denying claims. Therefore, they often find many reasons to deny disability claims. According to 29 C.F.R. § 2560.503-1 (f)(3), insurance providers must give the claimant their reason for denial—some of which are legitimate, and others of which may not be.
Claims reviewers must have objective information regarding a claimant’s disability in order to approve a claim for benefits. Depending on the medical condition, this can include doctors’ notes, lab test results, MRI results, and other medical records.
If a claimant received medical treatment for the same or a similar condition with a certain time period prior to the claim as listed in the exclusions portion of their policy, the claim may be denied. On the other hand, a review may deny a disability claim if the claimant waited too long to—or simply did not—seek medical treatment for their problem.
Sometimes an insurer makes treatment recommendations that go against the treating physician’s advice and care. The different treatment approaches can be grounds for a claim denial, as the insurance company can say that the doctor’s treatment is not appropriate. However, as any experienced ERISA disability claim denial lawyer in Texas can attest, this approach by insurers has been largely unsuccessful in cases that result in litigation.
Some disability insurance policies have exclusions that disallow self-reported or subjective symptoms from being used as a basis for disability. Such symptoms can be as common and seemingly innocuous as fatigue and dizziness. However, if this exclusion is not specifically listed in the claimant’s policy, this is not a valid reason for denial.
After a disability denial, a Texas ERISA disability claim denial lawyer from our firm could review all your options with you and help you decide what the best course of action is for you. If that means moving forward to an appeal or even to filing a lawsuit, our experienced ERISA attorneys are here to help.
We want to seek justice for you and see you have financial peace of mind during this difficult time period of your life. Call today to learn more about your options after an ERISA disability claim denial.
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