Nationwide Disability Insurance Appeal Process Lawyer
People who have had their long-term disability claim denied by their self-paid or their employer's ERISA disability insurance provider have the legal right to appeal the decision or seek damages through a lawsuit. The specific procedures for filing an appeal depends, in great part, on whether your insurance is self-paid or administered through your employer's ERISA plan.
Self-Paid Disability Insurance Plans
If your initial long-term disability claim has been denied, you are not obligated to file an appeal through a formal process, although the insurance provider will have a procedure for doing so. If you choose to file a formal appeal, the steps you must take are covered on your policy. The procedure is part of a contractual agreement and you must follow the instructions to the letter of the law. The steps are often complicated, requiring gathering additional medical records, doctor's diagnosis and reports, and these must be submitted according to specific instructions. Your insurance provider is obligated by the terms of the contract to pursue a further investigation and revisit the decision. In the end, the insurance company maintains control over the final appeal decision.
Binding Arbitration
Many national disability insurance providers include a provision for overturning a denied claim through a binding arbitration process, which is mandatory prior to filing a lawsuit. The process for filing for an arbitration hearing must be clearly defined on your policy. The arbitration process only allows for accepting the denied claim, or overturning the denied claim and awarding the compensation benefits. There are no provisions for punitive damages. You may have a lawyer represent your side at the arbitration hearing.
Filing a Bad Faith Lawsuit
If you have reason to believe that your insurance provider acted in bad faith when denying your claim, you may be able to file a lawsuit against the company. Technically, lawsuits seeking damages for a wrongfully-denied claim are considered contractual in nature. In a litigation matter, you may be able to seek an approval of your claim, as well as significant punitive damages for lawyer fees and other costs associated with the lawsuit. This will depend on the contract language of your insuring agreement or whether it is an ERISA plan or not. If you decided to file a lawsuit, it is a matter for the courts and is best handled by a licensed, experienced insurance litigation attorney.
ERISA Plans Appeals Process
Filing an appeal to overturn a denied claim through a disability insurance plan governed by ERISA is complex. Because your employer is involved, you may not have immediate access to the specific contract language specifying the appeals process. Many ERISA disability plans require an arbitration process that you agreed to when you accepted the disability insurance as a benefit through your employer. Your employer may face increased costs for excessive claims and, therefore, protect itself from exposure, as much as possible. The procedures require following precise steps and are best handled by a licensed lawyer with specific knowledge of ERISA disability claims law.
Free Consultation · Representing Policyholders Only · No Fees if Claim Not Approved
Greg Jones Law is the law firm to turn to for help at any step in the appeals process. Under the direction of disability insurance attorney Greg Jones, the firm has gained a national reputation for fighting aggressively to help claimants receive the full and fair benefits they need and deserve.
Greg Jones Law provides legal advice and representation for clients who have been denied claims from their disability insurance provider anywhere in the United States. From anywhere, call toll free 800-481-5707 or contact the firm by e-mail to arrange a free consultation with an experienced disability appeals attorney today.
