Disability insurance benefits provide substantial financial assistance as you recover from your injuries. It is supposed to be a safe cushion for you and your family when an injury impacts your ability to work. However, when insurance companies deny your disability claim, it can cause you to experience the stress that you wanted to avoid in the first place.
Receiving a denial letter regarding your disability claim can be stressful and excruciating. When you want to appeal the insurance company’s decision on your disability claim, allow the disability appeal attorneys at J. Price McNamara ERISA Insurance Claim Attorney to help.
Do not get stuck paying out of your own pocket for a disability that your employer-provided insurance policy should cover. We have decades of experience obtaining successful results in injury and disability cases, so reach out today for more information.
Table of Contents
- What is Disability Insurance?
- Why is Disability Insurance Important?
- What Benefits Come With Disability Insurance?
- How Long Do Disability Benefits Last?
- How a New Orleans Disability Appeal Attorney Can Assist with Your Case
- Speak with a New Orleans Disability Appeal Attorney Today
What is Disability Insurance?
Disability insurance is a type of insurance policy that can be purchased individually or as a part of an employee benefits package. Through this insurance policy, workers who can't work due to injuries or illnesses can cover their bills. The coverage received from disability insurance can pay an employee's mortgage, car notes, cell phone bills, and other household expenses.
Why is Disability Insurance Important?
Workers between 18 to 40 may not think they need to invest in disability insurance. However, the number of injured workers says otherwise. According to the Council for Disability Awareness, one out of four 20-year-olds will lose work for at least a year due to disabling conditions. When these workers become injured and have to take time off from work to recover, what financial protection can they still rely on as they recuperate from their injuries?
With disability insurance, workers can receive income to provide for themselves and their families. Depending on the disability insurance purchased, workers might fully cover their illness or injury.
What Benefits Come With Disability Insurance?
Unlike other employee benefits packages like workers' compensation, disability insurance can provide coverage for most medical conditions. Unless the medical condition is pre-existing or does not fall under the policy's definition of a disability, workers can file a disability claim for their illness or injury and receive benefits within a short time.
How Long Do Disability Benefits Last?
Depending on the type of policy you purchase and the nature of your medical condition, your disability benefits can provide coverage for you well into your retirement age. For example, long-term disability insurance is the insurance policy that can provide benefits for a period that ranges from two years to the employee’s retirement age. Short-term disability insurance, on the other hand, offers benefits for a period that ranges from seven days to a year. In any case, the period is pretty beneficial.
How Disability Insurance Benefits Employees
For employees, disability insurance can bring profound peace of mind to their financial situations. When workers suffer an injury, their first thought ventures to how their finances will be affected should they take time off from work to recover from their injuries. With disability insurance, financial coverage can be offered to the employee and help with the financial strain that would typically come if the employee was not insured.
One serious expense disability insurance can take care of for injured employees is medical expenses. Medical debt is one of the highest debts that American workers must pay. Disability insurance can help alleviate the employee's medical costs and ensure that the employee can still financially care for their family.
How Disability Insurance Benefits Employers
Disability insurance is a benefit to employers as well. When employees suffer an injury, there are many factors that an employer must consider, such as compensating the worker for their injury and retaining the worker. Disability insurance is a great solution allowing employers to have the best of both worlds.
Employers can ensure that employees receive the compensation they need to recuperate from their injuries and maintain a cordial relationship with the employee. The relationship has not fallen apart if the employee feels well enough to return to work after their injury. The employer can focus on helping the employee readjust to the position again.
Filing a Disability Insurance Claim
When a worker becomes injured, the first step they must take to receive their disability benefits is to file a claim with the insurance company. In the claim, a worker will provide a detailed description of their injuries and their job duties. Based on the policy, the worker may have to include other information such as their salary and further financial details.
The worker’s physician will also be responsible for submitting medical information about the worker’s injury. This information includes an explanation of the worker’s injury, a recommended treatment regimen, and evidence verifying that the worker cannot return to work due to their injury.
What Happens if They Deny Your Claim?
When you submit a disability claim to the insurance company, they can make only two decisions. The insurance company can either approve or deny your disability claim. When the insurance company decides to deny your claim, it can be for several reasons. Whatever justification the insurance company uses will be explained in your denial letter.
What options do you have once the insurance company has denied your claim? Well, it depends on what type of insurance policy you purchased. If you purchased your disability insurance policy individually through a private company, you can follow the laws of your state and file an administrative appeal against the insurance company’s decision.
If you purchased your disability insurance policy through your employer, you must follow the federal laws under the Employee Retirement Income Security Act (ERISA).
ERISA and its Impact on the Disability Appeal Process
The federal laws created through ERISA make the disability appeal process extremely strict for applicants. Before filing a federal lawsuit against the insurance company, you must exhaust all your administrative appeal options. That means you will need some resolution with the insurance company through the administrative appeal process before you can file suit.
To add even more pressure to the process, you must meet specific deadlines for the insurance company to even consider your appeal. All applicants must submit their evidence in an administrative record within the federal 180-day time frame.
How the Strict ERISA Requirements Can Work Against You
The strict 180-day deadline to submit all evidence is one of the ERISA requirements that can end up working against you. When you fail to submit all evidence within the designated time frame, it can seriously affect your ability to file a lawsuit in the future.
When you are late in submitting your appeal to the insurance company, you will not be permitted in the future to file a federal lawsuit against the insurance company regarding your claim.
Filing a Federal Lawsuit
Once your administrative appeals have been exhausted, you can file a federal lawsuit against the insurance company. However, the ERISA requirements also restrict the type of evidence that you are allowed to use in your lawsuit. The only evidence that the federal judge will consider in your lawsuit is all of the evidence presented in your administrative record.
This makes the preparation of your appeal essential. If you do not present your evidence in your administrative record, it will not be used or even introduced in your federal lawsuit.
Why Should You File an Administrative Appeal for Your Disability Claim?
When considering whether to file an appeal, it can seem the appeals process favors the insurance company. To some extent, that is true. The ERISA requirements increase the chances that the insurance company has legitimate means to deny your claim. Still, fighting for an appeal is one of the federal rights that you must exercise. Just because insurance companies have the right to deny a disability claim does not mean they are justified.
Filing an appeal ensures that you at least have a 50 percent chance of having your disability claim overturned. Even if the ERISA requirements favor an insurance company, the case you present during your administrative appeal can lead to an overturn. Instead of just accepting the insurance company’s decision, you can seek the help of a disability appeal attorney and fight for the disability benefits you deserve.
How a New Orleans Disability Appeal Attorney Can Assist with Your Case
You may find yourself ready to begin the appeals process but may be confused about how to proceed or what are the best steps for my case. At J. Price McNamara ERISA Insurance Claim Attorney, our seasoned disability appeal attorneys can bring a sense of clarity to your disability appeal process.
When going up against insurance companies who have several advantages they can use to justify your denial, you want an attorney who will fight for their client. Other benefits that our disability appeal attorneys bring to the table include:
The ability to examine your legal documents and create several strategies
An experienced disability appeal attorney can use their experience to carefully review and examine your legal documents. Because the denial letter contains reasons why the insurance company decided to deny your claim, an experienced disability appeal attorney can base their legal strategy on the information presented to you. Your disability appeal attorney can also review your disability insurance policy and search for potential loopholes.
Design the best strategy for your appeal process
An experienced disability appeal attorney knows how to navigate ERISA requirements and design the best strategy for their client. The strict ERISA requirements allow disability appeal attorneys to become creative in submitting the necessary documentation for your case.
There are also ways that a disability appeal attorney can advise you to act while you are waiting for the insurance company’s response to your appeal. Insurance companies have 45 days to respond to your appeal, giving them 45 days to search for any compromising information that can contradict your appeal. A seasoned disability appeal attorney can design the best legal strategy that will help you throughout the appeal process.
Serve as Opposition against the insurance company
Another benefit of seeking the legal help of a disability appeal attorney is having someone on your side who can truly challenge the insurance company’s tactics. Even for something as serious as disability insurance, insurance companies will search for various reasons to deny an applicant’s claim.
When insurance companies deny your initial disability claim, they do so with the hope that you do not follow through with the appeals process. With a seasoned disability appeal attorney on your side, you will feel better about your chances of being successful in your appeal.
Assist with providing evidence for your administrative record
Before filing a federal lawsuit, you will have to see if you can get the insurance company to overturn the appeal compromising with them. In an administrative appeal, you must file your administrative record with the best evidence possible.
A seasoned disability appeal attorney can help gather the best evidence for your administrative record. This is crucial because should your case proceed to a federal lawsuit, the only evidence that the court will consider moving forward is the evidence presented in the administrative record.
Speak with a New Orleans Disability Appeal Attorney Today
At J. Price McNamara ERISA Insurance Claim Attorney, our disability appeal attorneys understand how important this case is for you and your family. Your ability to financially provide and keep a roof over your head can change when the insurance company denies your claim. Allow our disability appeal attorneys to help.
Call our office at (504) 420-6962 or complete our contact form for your Free Denial Review with a New Orleans disability appeal attorney today.
New Orleans Office
829 Baronne Street
Suite 2B
New Orleans, LA 70113
Phone: (504) 420-6962
Fax: (225) 201-8313
(By Appointment)
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