Disability Insurance Denials
What happens if you get denied for long term disability insurance?
Understanding Long Term Care Disability
Long-term disability or LTD refers to disability insurance policies. There are basically two types of disability policies. At Daggett Shuler we have experience with both types of policies. If you have a question about a disability policy, you can talk to us for free.
The most common is “long-term disability benefits” that are offered by employers as part of an employee benefits package. Often combined with short-term disability, these benefits are available to employees if they become disabled through an injury or sickness while they are covered by their respective benefit plan. Most often, an insurance company that actually provides insurance coverage for the employees under the benefit plan processes long-term disability claims. The Employee Retirement Income Security Act or ERISA governs the claims procedures that employers must follow.
In addition to long-term disability benefits provided through an employee benefits package, long-term disability coverage can also be obtained through an individual policy purchased from an insurance company. These policies provide disability benefits to individuals that meet the policy’s definition of a disabling condition while they are covered under the policy. Since these policies are purchased privately from an insurance company, the ERISA statute does not govern them.
How do you file a claim for long-term disability benefits?
Most employer-sponsored plans have specific procedures that must be followed in order to file a claim for long-term disability benefits. Once a claim is filed, and then the claims administrator, which is usually an insurance company, has a certain amount of time to investigate and make a decision on the claim. If the claim is denied, then an individual usually has the right to challenge the decision through an administrative appeal. An individual’s rights and the procedures that must be followed for the appeal are specified in the ERISA statute and the benefit plan. If an individual’s claim is ultimately denied through the available administrative appeals, then the only recourse is to file a lawsuit under the ERISA statute.
When do you need an attorney to help you with your long-term disability claim?
Most individuals are able to file a claim for long-term disability benefits without the help or assistance of a disability attorney in North Carolina. Frequently, personnel from the employer’s human resources or benefits department can help an employee get the process started by filing a claim. However, if the claim is denied, then an individual should seek the advice and counsel of an attorney experienced in long-term disability cases. This is because the administrative appeal process is fraught with traps and pitfalls. The single most important pitfall is the failure to develop the administrative record during the appeal process. If this happens, then a case can be irreparably harmed for future litigation. This is because the administrative record is generally the only evidence a reviewing court will consider and the record is closed at the end of the administrative appeal process. Consequently, a claim has to be prepared for litigation during the administrative appeal process.
Daggett Shuler can help you with your long-term disability case!
At Daggett Shuler, our attorneys are experienced in handling ERISA and private long-term disability cases. Ideally, with employer-sponsored ERISA cases, we like to get involved as soon as the claims administrator denies the claim so that we can appeal the decision immediately. This allows us to develop the administrative record in the event a lawsuit has to be filed. If a claim is denied through the administrative appeal process, then we have the experience and knowledge needed to litigate the claim.
At Daggett Shuler, you can depend on us.