Assisting Houston Residents with Responding to an Insurance Company’s Denial of Long Term Disability Benefits

The main purpose of long term disability insurance benefits is to compensate workers when they are no longer able to work due to an injury or illness that is long term or permanent. People often take out these types of insurance policies through their employers. When that happens, the policy is usually covered under the Employee Retirement Income Security Act of 1974, sometimes called ERISA.

Under this federal statute, which was originally intended to protect employees, insurance companies have significant incentives and advantages. For one thing, if the case ultimately winds up in federal court, a judge, rather than a jury, will decide the outcome of the case.

Given these advantages, it is no surprise that insurance companies routinely deny applications for long term disability benefits. If your application for benefits has been denied, it is important that you seek legal help as soon as possible. The Houston long term disability denial lawyers at the Law Offices of J. Price McNamara can assist you with responding to a claim denial in a timely and efficient manner.

Elements of Proof and Reasons for a Claim Denial

In order to demonstrate that you are eligible for long-term disability benefits, you must be able to prove, through medical testimony, that your inability to work at any job stems from your injury or illness that is long-term, permanent, or both.

To be successful in making a claim for long term disability benefits, you need to have a healthcare provider who is on board with your case and who can establish that you are unable to work, to a reasonable degree of medical certainty, due to your permanent injury/illness.

When denying a claim for long-term disability benefits, insurance companies often point to a lack of sufficient medical documentation as the basis for their denial. When you get a denial letter, you should read it carefully and see exactly why the insurance company is denying your claim for benefits. That way, when you file an administrative appeal, you can hopefully correct the deficiencies and supplement the record with additional documentation.

Appealing Your Case to Federal Court

If you have exhausted all of the administrative appeals that your insurance company provides, you have the option of filing an appeal against the insurance company by suing them in federal court. In federal court, a judge will review the administrative record and make a decision about your entitlement to benefits.

Keep in mind that when the case is in federal court, you no longer have the ability to supplement the record with more documentation. Therefore, it is important that you do this at the administrative level.

A knowledgeable Houston long-term disability denial lawyer can assist you with appealing your claim denial administratively. Moreover, if you have exhausted all of your insurance company’s remedies, and the claim has still been denied, your lawyer can help you pursue federal court litigation.

Speak to a Houston Long Term Disability Denial Lawyer Today

The legal team at the Law Offices of J. Price McNamara is ready to assist you with appealing a long term disability benefits denial. To schedule a free case evaluation and legal consultation with an experienced Houston long term disability denial attorney, please contact us online today.