Frequently Asked Questions
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Did Your Disability Benefits Insurance Company Deny Your Claim?
Did your disability benefits insurance company deny your claim? Did your disability benefits insurance company deny your claim and tell you that it had a review of your file done by some doctor it hired? Did your disability benefits insurance company deny your claim and question your credibility?
On this last point, the disability insurance company probably didn't call you an out and out liar. In its letter telling you that it was denying your claim, it probably said something like it had your file reviewed by some doctor it hired and file review did not find "objective evidence substantiating your complaints" or something like that. But their calling you a liar.
Courts often take a dim view of disability insurance benefits insurance companies that turn down claims based on a file review while questioning the credibility of the claimant. One example is Javery v. Lucent Technology, Inc. Long Term Disability Plan, No. 12-3834 (6th Circuit, February 3, 2014).
Don't just let the disability insurance benefits company come up with some bogus reason to turn down your claim; contact Lexington, Kentucky disability insurance benefits lawyer Robert Abell at 859-254-7076.
How long do I have to appeal the denial of my claim for disability insurance benefits?
The answer should be 180 days. The federal law, ERISA (short for Employee Retirment Income Security Act) that applies to most disability insurance benefits claims requires 180 days be allowed for a claimant to appeal the initial denial of their claim for disability insurance benefits.
The letter you get telling you that the insurance company has turned down your claim should tell you how long to you have to appeal the denial. It could be less than 180 days. If you're not sure what to do, contact an experienced disability benefits lawyer. You can reach Robert Abell at 859-254-7076.
My disability insurance company is the Hartford Life group and it has paid its medical evaluator, the University Disability Consortium, $13 million since 2002. Will the review of my claim for disability insurance benefits be fair and unbiased?
A federal district court recounted how Hartford Life Group Insurance Company had paid its independent medical evaluation, University Disability Consortium, $13 million since 2002. The court stated that, since Hartford Life had paid UDC some $13 million since 2002, "Hartford knows that UDC has an incentive to provide it with reports that will increase the chances that Hartford will return to Hartford in the future -- in other words, reports upon which Hartford may rely in justifying its decision to deny benefits" and therefore would view UDC's opinions with "commensurate skepticism." Caplan v. CNA Financial Corp., No. 06-5865 (N.D. Cal. February 4, 2008).
Robert L. Abell, a Lexington, Kentucky lawyer, represents individuals on their claims for long-term disability insurance benefits.
What medical conditions are disabling?
The real issue is what medical conditions are considered "disabling" under your disability benefits insurance policy. The insurance policy will define what conditions are considered "disabling." You will almost certainly have to prove to the insurance company that your medical condition is "disabling" as defined in the insurance policy.
Also, many disability insurance policies change their definition of "disabling" after a certain period of time. For instance, many policies deem an insured disabled for two years if they are unable to perform the job they had when they became disabled. But after two years the insured is disabled only if they cannot perform any job. This is a big difference.
Robert L. Abell is an experienced disability insurance benefits lawyer in Lexington, Kentucky. If you have questions about your disability insurance benefits policy or your claim for disability insurance benefits, contact Robert L. Abell toll-free at 859-254-7076.
If my doctor represents that I am disabled, will the insurance company automatically start paying me my disability insurance benefits?
No. The United States Supreme Court ruled in the case of Nord v. Black & Decker that the insurance company was not required to give any special deference to the claimant's treating doctor. Nord's doctor concluded that he was suffering from rapidly deteriorating degenerative disc disease, advised him to stop working and certified to the insurance company that he was disabled. The human resources department of his employer, Black & Decker, backed his claim. Nonetheless, the insurance company, MetLife, got the opinion of a doctor who said that Nord could take pain medication and get up periodically to walk around at work and that he was not disabled. As a result, Nord lost his case seeking disability insurance benefits.
If my claim is denied, will the insurance company's appeal process be fair and unbiased?
Usually, an employee's claim for disability insurance benefits will be submitted to an insurance company that has a conflict of interest, meaning that it must decide whether it has to pay benefits to a claimant. Insurance companies make more money when they collect premiums and do not pay claims. Since insurance companies exist to make as much money as possible, it is unreasonable to expect that the insurance company's appeal process will be fair and unbiased. If you have a claim for disability insurance benefits that is going through the appeals process, you should hire an experienced disability insurance benefits lawyer to help you.
If I have to file suit, will I win if the judge decides that the insurance company was wrong in rejecting my claim?
Not necessarily. Most disability insurance policies have language in them that will require the judge in your case to decide not whether the insurance company was wrong but whether the insurance company was "arbitrary and capricious" in rejecting your claim for disability insurance benefits. This gives the insurance company some leeway. It also shows why it is so important that you have an experienced disability insurance benefits or ERISA lawyer helping you with your claim as early as possible in the process.
What does ERISA refer to?
? "ERISA" stands for the Employee Retirement Income Security Act, a federal law that was initially passed in the 1970's. ERISA defines and limits an employee's rights regarding a number of employment benefits. If you have a disability insurance policy available to you through your employment and your employer pays at least some of the premium, your rights on any claim for disability insurance benefits almost surely will be governed only by ERISA. Similarly, if you have a 401(k) plan available to you through your employment, your rights regarding it are almost surely governed solely and only by ERISA.
If I have to file suit, will I be able to explain to the judge at trial why I am disabled and can no longer work?
No. There will be no trial in your disability insurance benefits case. You almost surely will not be able to present any additional evidence beyond what was in the insurance company's file when it considered your appeal. It is important to submit all your evidence and any other information supporting your claim during the claims review and appeals process.