Disability is more common than you might think, and more than 25 percent of all twenty-year-olds will become disabled before retiring. This disturbing fact is why every worker should consider purchasing disability coverage that will replace their income. As insurance policyholders, we like to think that we will have fair coverage when we need it. Sadly this is not always the case.
Many people who have disability coverage through Hartford experience issues obtaining the benefits they deserve. Insurance companies like Hartford spend vast sums of money training their adjusters to pay as little as possible on their claims. These companies also have armies of lawyers to defend against bad faith claim denials or undervaluations. You have the right to hire your own attorney to evaluate your claim and ensure you receive the full benefits you deserve under your insurance policy
There are many steps to getting benefits under a long-term disability (LTD) insurance policy. The good news is that a Hartford disability lawyer at J. Price McNamara ERISA Insurance Claim Attorney can help at every step of the way.
Our Firm Gets Results
Many disability lawyers claim to be the best – so how do you know who is?
We let our results at J. Price McNamara ERISA Insurance Claim Attorney speak for themselves:
- $500,000: This was a settlement for a worker who was disabled in a car accident. His serious spinal injuries left him unable to perform the physically demanding – and dangerous work – he had been doing on offshore oil rigs.
- $490,000: Our client sustained a severe neck injury in a car accident, resulting in surgery. The insurance company refused to offer any amount to pay for this young man’s medical costs. After filing a lawsuit in federal court, the insurance company agreed to pay nearly a half-million dollars for our client’s serious injuries.
- $447,000: This was what our client, a registered nurse with children, recovered from a jury. Our client suffered injury through the negligence of a Walmart employee who left a dolly in the aisle. Walmart made a low settlement offer, so we filed suit in federal court. Our team proved to the jury just how much our client’s injuries were worth.
These are just a few of our firm’s many favorable results for our clients. You can read about more of our successes in both trial verdicts and settlements.
The Hartford reported billions of dollars in profits for last year, and the company statement reports “strong financial performance with meaningful growth.” This is largely due to increasing insurance premiums and limiting payments on claims to people like you. While the company can afford to pay your disability benefits, it will deny whatever it possibly can to keep profits for itself—and it pay its chairman and chief executive officer a reported $11 million a year, with several of its other officers making seven-figure salaries. The Hartford and its executives thrive while disabled claimants struggle to get the benefits they need.
That’s where J. Price McNamara ERISA Insurance Claim Attorney comes in.
Filing a Claim With The Hartford
The first step toward getting LTD benefits is filing a claim under the right policy. Some employers provide LTD coverage or offer it as additional coverage that employees may purchase, but not always. Even government employees may not have LTD benefits. (In fact, the Social Security Administration found that state and local government workers were less likely to have access to LTD benefits than those employed in the private sector.)
A disability lawyer can help you determine what disability benefits are available. If you do not have a private insurance policy with LTD benefits, you may still be entitled to Social Security disability insurance (SSDI) or state disability benefits.
Finding the right insurance policy or disability benefit is only the first step toward filing an LTD claim. You must file your claim within deadlines set by contract and by statute. Your claim must contain all relevant information, and you might also need to supplement it with documentation from your employer or doctor. And even after you have done all this correctly, there is still a good chance the company will deny it.
Insurance companies deny any possible disability claims on the initial filing. They reverse a fair amount of these decisions later, meaning that you do eventually receive benefits, but this requires an incredible amount of time and effort when you must contend with physical and emotional limitations. By hiring a disability lawyer to prepare your initial claim, you can reduce the chances of receiving a denial. Hiring a lawyer also shows the insurance company that you are serious about getting all the disability benefits the company legitimately owes you.
Appealing a Denial of Your Claim With The Hartford
According to the Social Security Administration (SSA), only 28.5 percent of all disability claims for Social Security and Supplemental Security Income (SSI) are allowed when initially filed. This denial rate means that the SSA denies more than 70 percent of all claims of the initial application. As a result, most applicants filing a disability claim with the Social Security Administration will have to appeal an initial denial.
Though these statistics are for Social Security, not private LTD insurance policies, they show how common disability claims appeals are with companies like Hartford. The appeals process can be long, tedious, and complicated. Without an attorney to guide you through the procedural requirements and substantive legal issues, it can be challenging to overcome the power of the insurance company to prove that you are entitled to benefits.
Proving You Are Disabled
To be entitled to LTD benefits, an applicant must prove that: (1) they are disabled,
(2) the disability has persisted through the contractual exclusion period, and (3) the disability prevents them from working. (The contractual exclusion period is usually the first 90 to 180 days after the medical condition first develops.) An insurance company can attack any of these findings or all of them at once.
You must prove the disability itself with documentation from medical providers. This documentation can also include statements from mental health professionals because psychiatric and behavioral health conditions also qualify for LTD coverage. Unfortunately, insurance companies are not always willing to simply accept your doctor’s findings. The carrier can require you to get an independent medical evaluation (IME) from their doctor.
Despite the name, someone who works for the insurance will perform this exam, and it can affect your legal right to insurance coverage. Let your disability lawyer know as soon as you receive notice that your insurance company requested an IME. Your attorney can protect your legal rights and challenge the findings of the insurance company’s doctor.
The insurance company might also question whether your disability keeps you from working. Your policy might pay benefits if you cannot work in your own occupation, but it is more common for a policy to apply only when the disability prevents you from working in any occupation. (Your disability lawyer can review your policy to determine which standard applies.)
In addition to medical evidence about your disability, your attorney might also get evidence from a vocational expert. This expert is a professional who can assess how your injuries affect your ability to earn a living. Your attorney will use the expert’s report to prove your eligibility for benefits and determine the type of work that you are able (or unable) to perform. If necessary, this professional can also serve as an expert witness at trial to help the jury understand why your disability prevents you from working.
Proving The Amount and Duration of Benefits You Deserve
The policy will cover a set portion (usually 60 to 80 percent) of your pre-disability earnings. Though this calculation seems straightforward, complicated pay structures often confuse it.
Benefits might cover overtime, bonuses, profit-sharing, or other compensation. An employee might also take stock options or other benefits instead of cash compensation. If you do not get advice from your own lawyer, the insurance company might reduce your benefits by claiming that this compensation does not count. You have the right to full compensation for all payable benefits under your LTD policy.
It might seem that LTD benefits have a clear start and end date.
Indeed, your policy states these terms clearly in the policy language, but disputes may arise about when these terms apply.
- Does your disability start on the day of your injury or the day of the diagnosis of your injuries?
- What about chronic pain that develops into a disabling condition?
- Or perhaps other chronic conditions, such as arthritis or carpal tunnel syndrome?
- What about psychological disorders that can worsen over time without treatment?
It is not always clear on what date LTD benefits will apply to a particular condition. It is also not clear how long a medical or psychiatric condition affects your ability to work. Some conditions might improve over time. Eventually, you might return to work, but an insurance company may push you to return to work before you can handle your job responsibilities. Our disability lawyers can help you prove the full length of time you deserve LTD benefit payments.
Proving Any Bad Faith In the Claims Handling Process
An insurance contract promises that the insurance company will pay benefits if the policyholder becomes eligible for them. But who enforces this right? What happens when an insurance company wastes time processing your claim, pays less than what you should receive, or improperly denies your claim altogether?
It is hard for an individual claimant to fight back against these types of policy abuse. That is why most states have enacted laws that prevent “bad faith” in the claims handling process. (Both the Texas Insurance Code and the Louisiana Revised Statutes require insurance companies to handle claims fairly.)
These laws prevent many types of negligent and improper conduct. More importantly, they allow claimants to enforce their rights by suing an insurance company for bad faith in the claims handling process. A claimant can sue an insurance company for these acts whether they received benefits or not.
Bad faith statutes create a legal cause of action that gives claimants the right to sue.
These statutes also specify the damages a plaintiff may recover after they successfully prove bad faith.
- First, the plaintiff may recover compensation for any financial losses that directly resulted from the claim denial. These costs can include credit card interest, late fees, and other costs that might not have occurred had the insurance company paid the benefits on time.
- Second, a plaintiff may recover any statutory fines that apply. Some statutes list a specific dollar amount that applies to each act of bad faith.
- Finally, a plaintiff might recover punitive damages. These damages do not compensate the plaintiff for a specific loss – instead, they punish the defendant for egregious actions. Punitive damages in bad faith cases discourage insurance companies from negligently handling claims. Punitive damages are usually available in only the most egregious cases of bad faith acts, so your case might not qualify. Speak to our experienced bad faith insurance claims lawyer to learn more about your specific situation.
Bad faith does not only apply to LTD policies. An insurance company can handle claims negligently on any policy. Our firm won damages and penalties for a couple whose homeowner’s insurance carrier wrongfully denied their claim. These clients went from complete denial to an award of the full policy limits of $155,000. The jury also awarded an additional $225,000 for the carrier’s bad faith handling of the claim. This case is just one of many of our successes—both at trials and in settlements.
Find Out if We Are the Right Long Term Disability Insurance Lawyer for You
Getting disability benefits can require a fight. Too many claimants are left to fight for the benefits they paid for when battling physical and mental ailments. This situation isn’t right, and you don’t have to fight a big insurance company on your own. At J. Price McNamara ERISA Insurance Claim Attorney, we work hard to defend disability claims and get our clients the contractual benefits they deserve.
Contact us today at (504) 420-6962 for your free case evaluation. The sooner you have an experienced disability lawyer on your side, the better we can protect your legal rights. We fight hard to ensure that our clients get the benefits they should when they most need them.
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 J. Price McNamara ERISA Insurance Claim Attorney, 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