How Physicians Can File a Successful Disability Insurance Claim or Appeal a Claim Denial
To Physicians Stuck in a disability insurance claim battle…
Take a note of hope from a former insurance company attorney (and proud husband and more recently father of two physicians), who now helps doctors and other healthcare providers win their long-term disability benefits claims, appeals and lawsuits nationwide:
Receiving a denial letter does not mean it’s over – not even close- you can overturn an unfair claim denial!
Disability insurance companies follow the same playbook to deny valid physician claims every day, knowingly interpreting their disability policies to find the physician-claimant “not disabled under the terms of the policy” even when the law clearly provides that you are.
Whether it’s a short- or long-term disability claim, YOU know your medical condition renders you disabled from adequately performing the full spectrum of the essential duties of your profession. And your own treating physicians – highly-trained specialists in the field of your disabling medical condition agree that you’re disabled.
So it’s a terrible feeling – You’re shocked by the disability insurance company’s denial letter while you’re handling the financial and emotional stress that comes with your disabling medical issue.
The denial letter likely over-generalizes your occupation, and glosses over the true rigorous physical and cognitive demands of your occupation, as actually performed. The denial probably relies on the opinions of the insurance company’s own doctors, who disagree with you and your treating physicians about your true physical and cognitive restrictions and limitations. And those doctors are often not even specialists in your own field, or in the specialty field of your medical condition.
Most of the physicians’ disability claims we’ve reviewed and fought have presented variations of that same script.
Whatever excuse they’re giving you, you’re thrown into the legal world of insurance policy definitions, administrative appeals, and likely, federal “ERISA” law.
You want to get the next steps right without guessing, and you’re exhausted by their claim process, as they want you to be.
But persevere - the insurance companies are often WRONG or BREAKING THE LAW, and if so you CAN overturn a denial.
The Win My Benefits Process, what we use and consider to be “best practices” for securing benefits or appealing a denial, is described below. You can use it as a guide, or contact us if you’d like help.