When your health reaches the point where you cannot work, financial help is the key to survival. However, you must first go through the insurance company that is the gatekeeper for your claim. Your hope is that your initial claim is strong enough to be approved. When you first file, you would include evidence of your disability and why you are unable to work. It helps to have the help of long term disability lawyers in Doylestown.
Fight Back When the Insurance Company Denies Your Claim
The insurance company may deny your claim, saying that your disability is not serious enough for long-term benefits or finding some other problem with your paperwork. There is really no risk for them in denying your initial claim because ERISA does not allow you to sue them for bad faith. At this point, you should hire an attorney if you do not already have one. ERISA does allow you to file an administrative appeal when your claim is denied. The first level of appeal is to the insurance company itself. They will have already given you a reason why they denied your claim, and you must present evidence that shows that you deserve benefits. This could include:
- Medical evidence
- Statements from vocational experts
- Witness affidavits and statements
- Medical expert testimony
You should err on the side of submitting everything possible that could bolster your claim. This will be the only chance that you have to introduce evidence for your appeal. If your administrative appeal is denied and you must file a lawsuit against the insurance company, you will not get another chance to add evidence to your file. Instead, ERISA locks down the record after the first administrative appeal, so you must put your best foot forward.
You Can Sue the Insurance Company
While the law generally skews the process in favor of the insurance company, they are not the judge and jury when it comes to your long-term disability claim. You have the ability to appeal the denial in federal court. There, the judge would review the record that was in front of the insurance company and make their own decision about whether you could receive benefits. You do not need to prove a mistake on the part of the insurance company. You just need to demonstrate that you are entitled to benefits. When dealing with claimants, insurance companies have a disproportionate amount of power. They act in the interests of their own bottom line, which can make your life harder. Hiring a long-term disability attorney is one way to level the playing field, especially when the insurance company is making things difficult. We stand up for you when the insurance company denies your claim or terminates your benefits. The law gives you the right to fight back, but you must come to the table with an experienced attorney to put your best case forward in the appeals process.
Contact a Doylestown Long-Term Disability Attorney
At The Garner Firm, Ltd., we help clients who are getting pushed around by the insurance company in the claims process. If you find yourself with a denial, contact us so we can help you file an appeal.