If you recently received an insurance denial from a disability insurance company, you’re not alone. It’s not uncommon for insurance companies to deny claims — even legitimate ones — early on. However, if you disagree with the company’s decision, you need to act quickly. You’ll need to prepare your insurance appeal as well as build up your evidence. Below, learn the essentials of a long-term disability insurance appeal from Jonathan M. Feigenbaum, Esquire.
Step 1: Review Your Insurance Denial and Plan Documents
Before you file an appeal, you and your long term disability lawyer should always carefully review your denial letter and the disability insurance plan’s documents. In its denial, the insurance company should outline the reasons it will not pay your benefits. These reasons might include the following:
- Insufficient evidence
- Failure to meet the plan’s definition of disability
- Missed deadlines or skipped waiting periods
- Exclusions and exceptions listed in the policy
- Lapsed coverage
Once you understand its rationale, you’ll have to review your application and the plan’s documents to assess the insurance denial’s accuracy.
Under the Employee Retirement Income Security Act of 1974 (ERISA), the disability insurance company must provide you with copies of your plan’s documents. These documents include a summary plan description (SPD) that outlines the policy’s requirements, procedures, and appeal deadlines. You can also get a copy of the full Plan Document, a long and complicated description of the policy’s terms and conditions. It is essential to get the Plan Document, because the SPD may not accurately reflect the true terms governing your claim.
When you work with Jonathan M. Feigenbaum, Esquire, we carefully review these documents and compare them to the insurance company denial. Our goal is to identify your strongest arguments as well as build a comprehensive appeal strategy. We also take care to follow the plan’s strict filing deadlines and procedures. If you need help getting your plan documents or understanding your denial letter, contact us today for a no-risk consultation.
Step 2: Consult With an Insurance Appeal Lawyer
If you’ve tried to read and understand your SPD or Plan Document, you might feel incredibly overwhelmed. An insurance appeal is a highly technical process that involves extensive knowledge of ERISA, medicine, and vocational studies. Most disabled people simply cannot complete an appeal on their own.
When you work with an ERISA lawyer who focuses on insurance appeals, you get peace of mind. The law firm takes over the following day-to-day tasks:
- handling of your claim,
- obtaining and reviewing documents,
- building your appeal strategies, and
- drafting detailed arguments on your behalf.
We navigate each policy’s unique standards of review and filing procedures, which can be difficult to identify and understand.
There are filing deadlines in long-term disability appeals, and it’s in your best interest to contact a lawyer as soon as you get an insurance denial. If you miss these deadlines, which vary from policy to policy, you might lose your right to compensation. And the longer you wait, the less time your lawyer will have to build your claims and stack your evidentiary record — factors which are essential to any appeal’s success.
Step 3: Stack the Evidence in Your Insurance Appeal
In almost every insurance disability claim, you have a limited time period where you can submit evidence. This evidence might include medical records, restriction slips, and opinions from doctors and vocational experts. If you do not provide information early on in your appeal, the federal courts might refuse to consider important evidence that supports your claim.
Too frequently, we meet with disabled people who waited until the last minute to consult with an ERISA lawyer and missed their evidentiary deadlines. In many cases, there’s very little we can do to help them.
When you contact a disability lawyer early on, you give them time to “stack your record.” Your lawyer will compile evidence that supports your disability insurance appeal and submit it to the company. The goal is to give the insurer as much compelling evidence as possible and make it difficult for them to deny your claim for benefits.
When you work with Jonathan M. Feigenbaum, Esquire, we pride ourselves on attention to detail. We scour our clients’ records and identify missing information that might advance their claims. Then, we work closely with their doctors and other experts, collecting the information that they need. Once we have a detailed and thorough appeal, we present the insurance company with our information and arguments — tirelessly advocating for our clients at every step.
Did You Get an Insurance Denial? Schedule Your Free Consultation
If you’re facing an insurance appeal, contact Jonathan M. Feigenbaum, Esquire today. Our experienced team of disability advocates will listen to your story, review your documents, and help you understand your legal options. Consultations are always free.