What should I do if my disability insurance claim is denied?
You do not have to accept a denial from your disability insurance carrier as the final word on your disability insurance claim. However, if you decide to pursue your claim after the insurance carrier has denied it, you must not waste any time doing so. Your policy may contain certain deadlines for pursuing your claim.
How should I proceed?
Prior to making an appointment with the disability attorney, it is important that you prepare for the consultation by gathering and organizing your evidence in a place where you can readily secure it.
What evidence will I need?
The following materials will provide valuable aid to the disability attorney in making an informed determination whether or not your case can be taken to the next level, and will minimize the necessary preparation time if a lawsuit is to be filed:
1. Get the denial in writing. You have the right to a written denial letter from the insurance company which includes disclosure of the basis for denying your claim. This letter is most important to the disability attorney if your case is to be pursued.
2. The terms and conditions of the disability policy. This is not just the sheet that discloses your coverages, or the promotional materials which you receive from your employer, but the actual terms and conditions of the policy, which should have been provided to you when you signed up for the policy. If you do not have a copy, make a written request to the insurance carrier for a copy. Usually, the best person to write would be the one who denied your claim.
3. Medical records. It is most important that you obtain as much of your medical records as possible prior to your first meeting with your disability attorney. The attorney can request copies of your records from your physicians and health care providers, with your authorization; however, for the attorney to do so adds to the preparation time and the expense of your case.
4. Written job description. Your employer should already have prepared a written job description of your job at the time that you became disabled. This is especially important in the event that the definition of disability in your policy requires that you not be able to perform the relevant and necessary functions of your occupation at the time that you became disabled.
5. Prepare a resume. A resume of your entire educational and employment history prior to becoming disabled may also become very important in the event that your disability benefits were discontinued when the disability definition changed from being disabled to perform the duties of your “own occupation,” to being disabled to perform duties of “any occupation,” given your education and experience.
6. Get copies and transcripts of any statements you have given to insurance adjusters. The familiar phrase, “Anything you say can and will be used against you,” also applies in disability cases, particularly when statements have been given, either in writing or over the telephone, to insurance adjusters. If you have given any statements, you should write a letter to the insurance adjuster and request written copies of any and all written statements which you have given and transcripts of any and all oral statements, as well.
7. Witnesses to your disability. Be prepared to provide the names, addresses and telephone numbers of important and reliable witnesses such as your medical care providers and friends, relatives or co-workers, who might provide important information about your disability.
What should I do after I have assembled my evidence?
1. Once you have assembled your materials, schedule an appointment with an attorney experienced in handling private disability insurance claims.
2. Let your attorney know whether or not you work for a state or local governmental agency, or a religious entity and that your disability claim was denied or discontinued. It makes a big difference that you worked for a governmental agency or a religious entity. Your legal rights and remedies are much greater than those of people who worked for private employers.