One of the most frustrating things after suffering an injury and applying for long-term disability insurance is having your claim denied.
After going through the lengthy and time consuming process of filing for long-term disability benefits, receiving a letter stating your denial can be very discouraging. It’s very important in this situation to not give up, or take this outcome personally. You also shouldn’t blame anyone for your denial.
It’s also important to understand that the road to financial recovery doesn’t necessarily end here. Refusals are often the first step in part of the entire process. It’s good to know your options.
This is also a good time to consider hiring a personal injury lawyer to help you on the pathway towards success. We’ve put together a list of actions you can take to set you in the right direction towards securing your benefits.
1. Understand Why You Were Refused
This is the very first step you should take when receiving your denial letter. It’s encouraged to take some time to read over everything stated in the letter and perhaps even get a second eye on it as well. The letter will clearly outline why you were unsuccessful. For example, it might say you lacked proper documentation, which could mean you may need to revisit your doctor for proper x-ray result forms, etc. This will determine how you will proceed in this process.
Common reasons for being refused include:
Not meeting the insurance policies guidelines as to what constitutes being “Unfit for work”
Different insurance companies have different biases as to what it means to be unfit for work. Your disability must prevent you from performing your current job, making you taking time off and losing wages. After two years, you must prove again that you still cannot perform your work.
Not meeting the insurance policies requirements for inclusion
For example, a disability related to drug and/or alcohol use, may not meet the definition of disability.
Unable to provide significant evidence
Conditions such as chronic pain syndrome, depression, post-traumatic stress disorder and chronic fatigue syndrome are harder to provide evidence for because the results aren’t plainly visible on medical tests.
Failure to perform certain tasks
These tasks can include having proper documentation in your file about your personal injury. This can include medical records, your personal information, etc.
Check your insurer’s policy as to what constitutes a pre existing condition. Pre-conditions are usually denied unless they were submitted in the first year of being insured.
2. Filing For An Appeal
Your denial letter will state how you can apply for an internal appeal, including the requirements and deadlines to do so. Everyone is entitled to file for one, or two levels of administrative appeals. It’s also important to note that if you end up suing your insurance company (see step #4) that it is required by Federal Law that you must use up both of your appeal attempts.
Although it sounds unlikely that the same insurer is going to revisit and accept your application, this is the most common and less intense way that people finally receive their benefits.
In this stage, it’s important that you gather as much administrative records that you can in favour of your case. Examples of favourable documents include:
Opinion letter from your physician
All relevant and applicable medical records
Third party reports from family and friends
There are opportunities available to settle for mediation, and in fact most of the time this is the outcome. This process is conducted by a neutral facilitator. The facilitator will research into the standings of both parties and determine whether it’s necessary to settle for a lump sum or take matters to trial. They take into account your condition, what you’re asking for, and the risks and costs associated with litigation.
4. Suing The Insurance Company
Sometimes you have to take legal action after a claim denied and sue to try and obtain your full long-term disability benefits. It’s important in this stage that you retain a good, experienced personal injury lawyer to help fight to get you what you deserve. It’s also important that you are quick to seek legal advice if you’re planning on suing. This means reaching out to experienced
lawyers, BEFORE you file for an appeal, or any of the above mentioned steps.
Conte Jaswal Can Help
You may be frustrated upon receiving your claim denial letter, but it’s not over just yet! We want to get you the policy you deserve.
An experienced insurance policy claim lawyer can help get you the benefits you are legally entitled to.
At Conte Jaswal, we are empathetic to your situation. We’ll fight for you and be your advocate when you go up against the big insurance companies. You do not have to do this alone.
Book a free, no-obligation consultation with us to discuss your options. Accidents happen, but we can help you get the compensation you need to recover.
Contact Conte Jaswal now to start getting your life back on track!