Wouldn't it be nice to have insurance covering most of your income if you suffer a significant injury? Fortunately, this type of insurance policy exists for many workers. Disability insurance can help you maintain your expenses after suffering a significant medical condition.
When you file a claim for disability benefits, you deserve to receive your benefits as quickly as possible. Unfortunately, it is common for many applicants to receive a denial from the insurance company. When an insurance company has denied your claim, the disability lawyers at J. Price McNamara ERISA Insurance Claim Attorney can help.
Reach out to our legal team to discuss your disability and how we can help obtain the benefits you need.
Table of Contents
- Reasons for disability insurance
- Medical conditions that qualify workers for disability insurance
- Types of disability insurance policies
- Types of workers who need disability insurance
- Common reasons that insurance companies use to deny disability claims
- Contact a Houston disability lawyer today
Reasons for disability insurance
Disability insurance policies offer several types of benefits to employees. One of the most significant benefits is financial coverage if the employee suffers from a common medical condition. Disability insurance can ensure that an employee receives a substantial portion of their income after being unable to work. Disability insurance policies can reward injured employees with compensation for suffering from injuries that are often common for employees.
One of the reasons why employees decide not to purchase disability insurance is that when employees think of disabilities, their minds often resort to severe disabilities like traumatic brain injuries and spinal cord injuries. Disability insurance offers coverage for employees whose ability to work is often impacted by medical conditions that are more likely to affect an employee’s ability to work.
Medical conditions that qualify workers for disability insurance
Some of the medical conditions that can compromise an employee’s ability to work include:
- Musculoskeletal conditions
- Respiratory illnesses
- Blood disorders
- Mental disorders
- Cardiovascular conditions
- Immune system disorders
Types of disability insurance policies
When deciding to purchase disability insurance, you can choose from several options.
Some of the types of disability insurance include:
- Short-term disability. This type of disability insurance provides maximum benefits to employees who have suffered a temporary disability within 14 days after suffering an injury.
- Long-term disability. This type of disability insurance rewards maximum benefits to employees whose injuries are more permanent. The waiting period for benefits to kick in ranges from several weeks to several months.
- Individuals. Employees can also purchase a disability insurance policy for individual coverage. An employee can customize their policy at a higher premium with individual coverage.
- Group. Employers can also offer employees disability insurance policies at a group rate. Group disability insurance coverage applies to all eligible employees and results from a person’s employment. Once the person changes or loses their job, the disability insurance no longer applies.
Types of workers who need disability insurance
Many young workers ignore the benefits that disability insurance can bring. Because most workers get injured at work or suffer a severe illness outside of the workplace, disability insurance is excellent insurance coverage for an emergency. Some workers who can benefit from disability insurance include parents, workers in physically demanding jobs, workers with recurring injuries, and workers who are the primary providers for their families.
Men and women who have small children at home can benefit from disability insurance. Disability insurance can provide financial assistance to parents who have become sick or injured and still need to provide for their families.
Workers in physically demanding positions
Construction workers, nurses, and warehouse workers are just some of the physically demanding occupations in the country. Even if these workers do not get injured at the workplace, these workers can suffer from repetitive motion injuries, back pain, and other physically straining injuries.
Workers with recurring injuries
Workers who suffer from chronic back pain and constant injuries can benefit from disability insurance. This insurance coverage can help workers when they need to take time off work for medical reasons. With disability insurance, workers with recurring injuries can still have a significant amount of their paycheck while recovering from them.
Workers who are the primary providers for their families
For workers who are the sole breadwinners of their families, disability insurance coverage can provide peace of mind. If these workers are sick or injured and cannot work for a certain period, disability insurance can ensure they can still financially provide for their families.
Elimination periods for short-term and long-term disability insurance
Short-term and long-term disability insurance policies have an elimination period. An elimination period is a period in which workers must wait to receive their benefits from the insurance company. It is the period from when the worker is sick or injured to receive benefits for their injury. The elimination period begins on the day of the worker’s injury.
Short-term disability insurance policies have an elimination period from 30 days to 12 months. Long-term disability insurance policies have an elimination period from two years to a worker’s retirement age. In general, disability insurance plans with a longer benefit period have a higher premium.
What actions can help strengthen your disability claim?
When you submit a disability claim for your illness or injury, one action that can strengthen your claim is how well you document your illness or injury. You can properly document your injury by regularly attending visits with your physician and taking notes.
Another way to properly document your injury is to inform your physician of any limitations you are feeling and request medical notes from the physician of your limitations. You also want to keep track of your medical records because the insurance company will request them along with your claim.
What to do if your disability claim gets denied
Receiving a denial from the insurance company is not the end of your disability claim. You can exercise several options after a denial. If you bought your disability insurance policy through your employer, the chances are that your policy comes under the Employee Retirement Income Security Act (ERISA).
ERISA is a federal law that offers federal protections to employees’ insurance plans. ERISA regulations grant workers the right to appeal the insurance company’s decision. Workers with ERISA-covered disability insurance plans must follow the appeals process within the mandatory time frame.
Rights in ERISA disability claims
With ERISA-covered disability insurance plans, your rights have been somewhat restricted. One of the restrictions includes the short time frame to file an appeal on your behalf. Every worker has a 180-day time frame to file an administrative appeal.
Another restriction includes the inability to submit new evidence regarding your claim. In addition to filing your claim, you must submit an administrative record that will be the closest thing to a testimony you have in your appeal. The only evidence a judge may weigh in the appeal is the evidence in your administrative record.
How important is my administrative record in my appeal?
Your administrative record plays a significant role in your administrative appeal and your case moving forward. If your administrative appeal gets denied, you still have the option of exhausting all administrative options until you can file a federal lawsuit.
The only evidence the federal judge will examine during your federal lawsuit is the evidence submitted in your administrative appeal.
You may not introduce new evidence to the court at any point in your trial. That is why you want to include as much favorable evidence in your administrative record as possible.
Mistakes that many workers make during their appeal process
One of the most critical mistakes many workers make during their appeal process is not submitting the proper evidence in their administrative records that can serve as proof of their disability. This evidence includes medical opinions, objective medical testing, job description evidence based on the federal government’s Dictionary of Occupational Titles, and medical expert reports.
Why you need a Houston disability lawyer
During the administrative appeal process, you have the right to be represented by an attorney. While you have the option of representing yourself during an appeal, having a seasoned disability lawyer on your side can increase your chances of having your denial overturned.
At J. Price McNamara ERISA Insurance Claim Attorney, we understand what is on the line regarding your disability benefits. The ability to financially cover your family’s expenses and household depends on your disability benefits. Because there is so much riding on the line, our disability lawyers will do whatever it legally takes to ensure you receive the benefits you deserve.
How a disability lawyer can help you
Because your rights with an ERISA-covered disability insurance claim are limited, you cannot afford to make mistakes or leave anything up to chance. An experienced disability lawyer can help properly prepare your administrative record. Your disability lawyer can gather the best evidence to present in your administrative record and assist you with meeting the tight deadlines and regulations with your administrative appeal.
Your disability lawyer has experience with keeping in constant communication with several parties. An experienced disability lawyer knows how to stay in continuous contact with the insurance company, medical experts, and yourself. Your disability lawyer can bring peace to appeals by keeping you up to speed with the latest updates.
Clarity with legal jargon
A seasoned disability lawyer can also review several of your legal documents and bring a sense of clarity to the technical language used in each document. There is information in every type of legal document you possess that a disability lawyer can use to your advantage. One of those documents includes your denial letter.
The insurance company must offer an extensive explanation for your claim’s denial in your denial letter. Another important document that your disability lawyer can use to your advantage is your disability insurance policy. Disability lawyers can review the terms, conditions, and definitions within your insurance policy to catch any potential errors overlooked by the insurance company.
Presenting your disability efficiently
An experienced disability lawyer also knows how to present your condition in the most favorable way possible. The evidence that a disability lawyer can gather helps explain how your condition meets the insurance company’s standard definition of disability. An experienced disability lawyer can also gather evidence that proves that the insurance company’s decision resulted from a lack of substantial evidence.
Common reasons that insurance companies use to deny disability claims
One of the reasons why you should not be discouraged when receiving a denial letter from an insurance company is because it is common. Many insurance companies will often deny the first disability claim that an applicant submits.
Some of the common reasons that insurance companies use to deny disability claims include:
- Your policy does not cover your conditions. Some insurance companies will argue that their policy does not cover your medical condition.
- A pre-existing condition caused an individual’s medical condition. Disability insurance policies do not provide coverage for an individual’s pre-existing conditions and often request an individual to inform the company of any pre-existing conditions before coverage.
- Lack of sufficient evidence that can support a disability. When key evidence like medical reports and testing are missing from the claim, insurance companies can deny a disability claim. There must be enough evidence that can prove the existence of a disability.
- Refusal to complete an independent medical examination. With long-term disability insurance policies, in particular, insurance companies are allowed to request that you have an independent medical examination performed. Even though independent medical examiners present themselves as objective, they usually work in the insurance company's best interest. Still, refusing an examination can result in a denial. Please call us before you submit to an IME so we can prepare you for it.
When disability insurance companies issue denials for phony reasons, call us. We know how to counter those arguments.
Contact a Houston disability lawyer today
You can alleviate stress when your disability insurance company denies your claim by contacting J. Price McNamara ERISA Insurance Claim Attorney. Our disability lawyers can present the best case possible to help you receive your desired verdict.
Call our firm today at our Houston office at (713) 300-0462 or complete our contact form for your free consultation. You deserve compensation when missing work due to an approved disability. Do not let your employer or their insurance company say otherwise.
2000 Crawford St
Houston, TX 77002
Phone: (713) 300-0462
Fax: (225) 201-8313 (By Appointment)
"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."