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With so many changes happening in the workplace, one fact remains the same: workers are still at risk of getting injured. Whether injuries happen outside or inside the workplace, injured workers may worry about how they will provide for their families. If you want to avoid being in this predicament, one of the greatest benefit packages that you can consider purchasing is disability insurance.
Disability claims are complicated matters, so you should consider consulting with a New Orleans disability lawyer from J. Price McNamara ERISA Insurance Claim Attorney, who can help review your policy and claim. We have spent decades helping disabled clients obtain the benefits they need and deserve.
The last thing you want is to file a claim for disability benefits that you need only to discover that the insurance company has denied your claim for various reasons.
When many workers think of financial coverage for their injuries, disability insurance may not be the first option that comes to mind. However, this type of insurance policy can offer the most coverage for employees.
Disability insurance can provide most of the worker’s income if the worker becomes seriously injured. Even if the worker suffers temporary injuries, employees can use different types of disability insurance policies to cover their financial situations.
You may be thinking that because you have workers’ compensation insurance, you should not have to pay for additional benefit packages like disability insurance. However, there are a few differences between disability insurance and workers’ compensation.
One difference is that workers’ compensation only covers injuries that occur at work.
If the injury is not work-related, chances are you will not receive financial compensation for your injuries. Disability insurance can offer financial compensation for your medical condition if it meets the standard definition of what your policy declares a disability. That means that regardless of whether the medical condition happened outside of work, you can still receive financial compensation as you recover.
Another key difference is that there is more of a variety of medical conditions that disability insurance can cover. Workers’ compensation benefits can be available to you if you suffered a work-related accident that the employer can be held liable for. With disability insurance benefits, you can receive financial compensation for medical conditions you do not normally receive workers’ compensation for, like repetitive motion injuries that worsen over time.
Some of the reasons why workers can benefit from disability insurance can include:
These situations are more likely to happen to workers than a serious work-related accident. Disability insurance is a great way for workers to remain financially covered as they deal with their temporary or permanent disabilities.
Whether your disability insurance policy is short-term or long-term, you must file a claim with the insurance company to start receiving your benefits. While each process varies, each claim requests that you explain in detail the nature of your illness or injury and medical proof that can verify how your medical condition prevents you from performing your job.
With long-term disability insurance plans, however, one part of the claim process can affect your ability to seek approval for your claim. That part is the independent medical examination.
Suppose you have a long-term disability insurance policy and file a claim for your illness or injury. In that case, the insurance company will request that you have an independent medical examination performed. An independent medical examination is a medical assessment performed by a physician chosen by the insurance company.
During this examination, the physician will question you about your symptoms and the following limitations related to your injury. Many workers are suspicious of having an independent medical examination performed, and rightfully so. While the physician may seem nice and professional, the physician is working in the insurance company’s best interest and will use any details you provide against you and your claim.
Insurance companies can request an independent medical examination during any part of your claim process. However, insurance companies often request these examinations at the beginning. They may deny your disability claim if you refuse an independent medical examination.
If you feel apprehensive about having an IME performed, there are actions that you can take to protect your best interests. One action includes taking notes during the medical exam; make sure to take note of the length of the medical examination, the types of questions asked, and the medical tests performed. You can also bring a trusted relative or friend who can serve as a witness.
Like many insurance claims, your disability claim is in jeopardy of being denied. The reasons why an insurance company will deny your claim can vary. The insurance company may deny your claim because you refused an IME. Maybe the insurance company assumes you are attempting to receive coverage for a pre-existing condition, which is prohibited.
Maybe the insurance company feels that the medical information you submitted is not enough evidence to verify the limitations of your injury. Whatever the reason, you have the right to appeal the insurance company’s decision through the Employee Retirement Income Security Act (ERISA).
ERISA is a federal law granting federal protections to employees’ retirement plans. In addition to retirement plans, other employee benefits packages protected through ERISA are life insurance policies, health plans, and disability insurance policies. ERISA enforces federal regulations that protect these plans from abuse and mismanagement.
Three federal organizations that help enforce ERISA laws include the Internal Revenue Service (IRS), the Pension Benefit Guaranty Corporation, and the Employee Benefits Security Administration.
ERISA laws play a major role in your appeals process. If your disability insurance policy is a group plan, you will have to act under the laws that govern your group plan. This includes filing an administrative appeal against the insurance company 180 days after receiving your denial letter.
While ERISA laws provide some protections for policyholders, they often give insurance companies major advantages in the appeal process. You cannot file a federal lawsuit against the insurance company until you have exhausted all administrative appeal options.
Another disadvantage of ERISA is the limited ways it holds an insurance company liable for denying your disability claim. State laws allow you to file lawsuits against insurance companies and hold them liable for claims like bad faith practices and breach of contract. Even if your appeals process leads to a federal lawsuit, you can only hold insurance companies liable for your disability benefits and attorney fees.
Another limitation you will face in your federal lawsuit is the lack of evidence you can present in your trial. Instead of conducting a jury trial, a federal judge will review your case and the same evidence that the insurance company used to deny your claim. You cannot introduce new evidence to the judge regarding your disability claim. The only evidence that the judge will consider is the evidence that is in your administrative record.
Another limitation that the ERISA laws cause in your appeals process is the mandatory request to exhaust all administrative appeal options with the insurance company. This limitation benefits the insurance company because the insurance company takes the lead during many steps in the process.
If the insurance company wants to stall and prolong the process, they can. For example, insurance companies have 45 days to respond to your initial appeal. If the insurance company wants to extend that waiting period to an additional 45 days and request additional information from you, they are allowed to do so.
With the strict regulations you must follow, and the tight deadlines you must meet, engaging in the appeals process for your disability claim can seem overwhelming. When you want to exercise your ERISA rights and overturn the insurance company’s decision, you want an experienced disability lawyer on your side. Never represent yourself at any point during the appeal because you have too much riding on the line.
You do not want to jeopardize financial coverage that can provide for you and your family by guessing your way through the process. A New Orleans disability lawyer can increase your chances of seeking the outcome that you desire for your case.
An experienced disability lawyer is knowledgeable about the ERISA laws and how to use them to your advantage. Even though the ERISA laws tend to benefit the insurance companies, there are ways that you can overturn the insurance company’s decision and receive your disability benefits. Your disability lawyer can use their knowledge of ERISA laws to help you craft the best possible administrative record for your case and ensure that the insurance companies do not get away with their unfair decision.
Another benefit that a disability lawyer brings to the table is being efficient within tight deadlines. Although 180 days seems like plenty of time, the evidence you want to collect for your administrative record can often be difficult to obtain within that time frame.
A qualified disability lawyer knows how to constantly communicate with several parties and remain organized throughout the case. Your disability lawyer can assist with filing the appeals process, gathering the best evidence for your administrative record, and analyzing how these pieces of evidence can strengthen your chances for success in your case.
Another way that a disability lawyer can help you is by counteracting the insurance company’s tactics. Because insurance companies have the upper hand in the appeals process, it is easy for insurance companies to take advantage of you or use questionable evidence to verify their denial.
In addition to stalling the administrative appeal process, insurance adjusters can take pictures of you around town, stalk your social media profiles, conduct interviews with your coworkers, and collect video evidence of you engaged in hobbies or performing physical tasks.
Your disability lawyer can use credible evidence to prove that the insurance company’s evidence is weak. The more the appeal progresses, the more you may find the insurance company lacks the legitimate evidence it wants you to believe it possesses. Having a disability lawyer in your corner is a great way to show the insurance companies that you are serious about pursuing an appeal for your claim.
When you file for disability benefits, you expect the process to flow as smoothly as possible. You do not expect the insurance company to deny your claim based on flimsy reasons. Receiving a denial letter when you are expecting your coverage can be devastating.
At J. Price McNamara ERISA Insurance Claim Attorney, our disability lawyers are passionate about helping you fight for the benefits you deserve. Call our office at (504) 420-6962 or submit our contact form for your free consultation with a New Orleans disability claims attorney today. When you have questions about your disability claim, an experienced lawyer can make a world of difference in your case.
829 Baronne Street
New Orleans, LA 70113
Phone: (504) 420-6962
Fax: (225) 201-8313
“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.”
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 the Law Offices of J. Price McNamara, 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