Give the burden to us. Regain your peace of mind.
We’ll take it from here. Call now.

Free Case Consultation
Search

3 Reasons Not To Panic After A Disability Denial

The Next Steps Are Critical. As A Former Insurance Company Attorney/insider, I’ll Personally Guide You Through Those Steps And Around Common Pitfalls

Before You Hire Any Attorney, Let Me At Least Do This For You (Free Of Charge):

  • 1 Review Your Denial Letter;
  • 2 Discuss the denial and insurance company tactics in your case with you by phone; and
  • 3 Give you a written step-by-step plan to fight your denial.

Call me or fill out the contact form to get started today.

You can use the plan continue your fight alone, or share it with any other attorney you wish.

Or if you decide you want me to fight for you, no office visit is needed, and you pay nothing – no fee, no costs -- unless we recover.

Listen About Long Term Disability

3 Reasons Not To Panic After A Disability Denial

If your insurance company denied your disability claim, you shouldn’t shift into panic mode. Insurance company denials often follow a distinct pattern. You submit a claim. You follow their instructions. You anticipate a payment, then a rejection letter arrives. Of course, it’s frustrating. It’s not what you expect, but a disability denial letter doesn’t mean that it’s over.

If you believe your insurance company should cover your disability claim, you have a right to demand reconsideration. If your insurance company doesn’t properly address your inquiries, you have access to a progression of resources to hold them accountable. Disability attorneys understand the complex issues involved. They are your first-line resource for resolving claim denial issues. Here are three additional reasons why you shouldn’t panic.

 

1. You Can Reestablish Contact With Your Disability Insurer

When an insurance company rejects a claim, they realize that some people simply go away but others won’t. That’s why insurers maintain your claim documentation until you no longer have a legal right to make a claim. Your claim file should include your documentation, medical records, and the insurance company’s rationale for denying your claim. If you want to know why they didn’t pay, you have a legal right to demand access to the answers in your file.

 

An Insurance Policy is a Contract

The insurance policy that provides your disability coverage is a contract. It grants you certain rights and benefits in exchange for a premium. If your coverage is part of a group plan and your employer pays the premiums, your role as a beneficiary entitles you to an explanation of your disability denial. An insurer must explain how and why your claim isn’t covered under the policy terms. Even if your disability denial letter didn’t thoroughly explain their reasons, your claim file should document relevant claim issues such as these:

  • Your disability wasn’t covered by your policy terms.
  • Your disabling condition occurred outside the policy period.
  • The policy specifically excluded the incident you’re claiming.
  • Your physician doesn’t agree that you’re disabled.
  • Your documentation didn’t meet the standard of proof.

You Can Dispute Your Disability Denial

You can compel your insurance company to provide reconsider their decisions. You can ask for a better explanation than the one in their formal disability denial letter. You may also request documentation from your claim file and a complete copy of the applicable insurance policy. The additional information you obtain should help you understand whether their position is valid.

If you’re still not satisfied and the insurer won’t reconsider their disability denial, you have alternatives. This is important because some insurance contracts contain clauses that require dispute resolution via binding arbitration. Others must grant you permission to file suit, but they do so only after you comply with all policy conditions.

 

2. You Have Legal Rights Under Louisiana Law

If your disability insurer doesn’t respond to your inquiries, you can assert your rights under Louisiana Revised Statutes. Under LRS 22, §1964 “Methods, acts, and practices which are defined as unfair or deceptive,” insurers have a legal duty to supply the answers to your questions. Provision (14) prohibits insurers from “Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies.”

The Louisiana Department of Insurance allows you to make a complaint without filing a formal lawsuit. You may complete an online complaint form to initiate the process. Before they take action, they may ask you to attempt to resolve your differences with your insurer.

 

3. Employee Retirement Income Security Act Regulations Provide Additional Support

ERISA Section 503 regulations implement standards that employers must follow when administering certain employer-sponsored disability plans. The agency revised its claim guidelines after research supported the theory that insurers disputed long-term disability claims as a cost-containment measure. The agency determined that 64.5% of ERISA-related coverage litigation involved long-term disability denials. Health care disputes made up 14.4% of ERISA-litigated cases. Pensions made up only 9.3%.

ERISA requires employers to inform employees of their available benefits. They must also handle certain claims based on ERISA regulations. Employers must provide each employee with a Summary Plan Description. The document must explain the plan type, benefits, availability, employee contributions, termination information, claim handling procedures, and other details. An SPD must also explain any coverage dispute processes and any rights available under ERISA.

 

Do You Need a Lawyer to Help You With Your Disability Denial?

Disability claims present complex submission and compliance requirements. They’re subject to coverage denials even when you fully comply. Before you decide to shoulder the responsibility or you shift into panic mode, consult with a disability attorney. Attorneys understand state and federal regulations and statutes and claim submission complications. They interact with insurance companies, employers, and government agencies. It’s an overwhelming process for a person who’s recovering from disabling injuries.

Your initial disability consultation is usually complimentary. You discuss your claim circumstances with a legal representative and receive feedback about your legal options. If your insurer has already rejected your claim, an attorney explains your alternatives and informs you of any important deadlines. If you want to move forward and fight your disability denial, the decision is up to you.

 

FAQ

What happens when you get denied for disability?

Disability denials can seem devastating, but it is not the end of the road. In most cases, there are multiple steps you can take in order to ensure you get the benefits you deserve. Disputing the denial alongside an experienced attorney will give you your best chance at a favorable outcome.

How do you fight disability denial?

Oftentimes, fighting a disability denial means providing more documentation to prove your disability. You have rights under the law that allow you to dispute a disability denial. An ERISA lawyer will be able to review your case and help you determine the best way to proceed after a disability denial.

How can I increase my chances of getting disability?

The best way to increase your chances of getting disability is to make sure your documentation is thorough and detailed. It is also best practice to speak with an ERISA Disability Attorney in order to help create an airtight case for disputing a disability denial.

 

Talk to an ERISA Disability Denial Attorney Today

Receiving a denial from an insurance company can be devastating, and many policyholders and beneficiaries feel helpless and confused. Such feelings are normal after a denial, but it is important to remember you may be able to take legal action against an insurer and obtain the benefits you need to survive. Call an ERISA Long-Term Disability Denial Lawyer today to learn more.

Our Client Testimonials

Contact Us Today

Complete the confidential form below for a free, no obligation case evaluation and we’ll tell you how we can help.
You may also call us at the number below.  J. Price McNamara and his legal support team are focused on building a strong case for you.

  • This field is for validation purposes and should be left unchanged.

Three Office Locations

Baton Rouge Office

10455 Jefferson Hwy,
Suite 2B
Baton Rouge, LA 70809
Phone: (225) 201-8311
Fax: (225) 201-8313
(By Appointment)

New Orleans Office

4141 Veterans Memorial Blvd.
Suite 212
Metairie, LA 70002
Phone: (504) 458-8455
Fax: (225) 201-8313
(By Appointment)

Houston Office

363 N Sam Houston Pkwy E
Ste 1100 PMB, #114
Houston, TX 77060
Phone: (713) 439-0339
Fax: (225) 201-8313
(By Appointment)

Attorney Advertising. This website is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Testimonials are not a guarantee, warranty, or prediction of the outcome of your case. By providing certain contact information herein, you are expressly authorizing the recipient of this message to contact you via the methods of communication provided.

Copyright 2020. All Rights Reserved

Call Now Button