APPEALING DENIED PRIVATE DISABILITY INSURANCE CLAIMS.
When you encounter an injury or medical condition that will put you out of work for some time or for the rest of your life, you probably will make a claim against a disability insurance company. Many businesses have private disability insurance that will cover these events, or you have purchased your policy. These policies are different from Social Security Disability Benefits that are from the government.
As with most insurance company claims, they will deny the claim for benefits and try to put you through hoops and loops to make you give up.
We, at Dyson Law PLLC, have seen this over and over again.
When you encounter these problems, you need to find a Delray Beach private disability benefits attorney that can gather the evidence, look at the internal appeals, civil litigation, and handle negotiations. Insurance companies will try various tactics to get you to give up and believe you don’t have a chance. However, these are simply just tactics that frequently work on people without attorneys.
If you are off work due to an injury or medical condition, you are entitled to benefits!
Policies vary for private disability insurance coverage.
Private disability insurance coverage will vary greatly by what the policy says and its interpretation. No one trained you to read the insurance policies to the fullest extent. But we, at Dyson Law PLLC, have the training and experience are trained and experienced to comb through your policy to determine if you have a case. Insurance companies deny claims for many reasons, but some common justifications are:
- Insufficient documentation of evidence that supports your disability condition.
- Exclusion of coverage applies. Things, such as you intentionally did this to self-harm, you had other situations such as military involvement that caused the issue, or acting dangerously.
- You are exaggerating your injury and have been caught with inconsistent results or on camera.
- There was an error in the original application.
- You didn’t explain things clearly.
- Coverage has since lapsed.
- Adequate medical treatment isn’t available, so there has been a severe lapse in coverage.
- And more!
Don’t think you are out of options!
Don’t think that you have no options just because you have a denied claim. Insurance Companies deny claims all of the time. When you involve an attorney, it often turns that around rather quickly.
The insurance company’s job is to convince you that you don’t have a claim by using poor excuses. When this happens, you need to find a qualified private disability insurance attorney near you that can take your case and get you the results you are entitled to under the policy.
There are three main types of disability.
1) an ERISA policy,
2) a private disability policy, and
3) government benefits.
What is ERISA?
The ERISA, Employee Retirement Income Security Act, is a federal law that applies to some companies. ERISA applies to companies that fund the benefits. In other words, the companies use their own money to fund benefits instead of the insurance company’s assets. Now often, these companies will hire someone to process their claims, so you must deal with an insurance company. But the money paid out is from the company’s bottom line.
Challenge disability denial
In 1974, Congress initially set up ERISA to help the system from getting overwhelmed with false claims on either side- the claimant and the company. Ideally, this system is supposed to be fair and just for both sides. Unfortunately, it has developed into a system that favors companies over individuals. In ERISA policies, there are ways that you can appeal to what the insurance company decided. People claiming benefits must jump through several hoops to appeal a denial.
First, they must go through an administrative process, meaning that they need to try to agree using their company’s systems before going further to Court. You need to send an appeal with documentation to the company. Then, a different person evaluates it at the insurance company. At this stage, you should have an attorney present to represent you.
Timing is everything!
For the disability plans governed by the ERISA, there is a strict timeline. If you miss a deadline, you might lose out. Most of the time, you have 180 days after receiving your denial to appeal and send any documentation to support your disability. If you fail to do so, that tells them that you accept their rejection, and you aren’t going to persist further.
You need to contact a lawyer the moment the denial letter is in your hand. During the lawsuit, the medical evidence is often limited to what is known as the administrative record. That includes all the forms completed by you, your doctors, and medical records submitted by you. You have to provide all of the documents with your appeal within those 180 days.
While you have 180 days, they only have 45 days to accept your denial and go over the information again. During this time, they can ask for up to two extensions; if the case is complicated, they will most likely take the extensions.
While the internal process may seem to be a waste of time, it really can be beneficial, especially if you were a person that didn’t have the proper attorney the first time.
At Dyson Law PLLC, we can go over things and ensure the company has the proper documentation to make the decision you want.
If the insurance company looks over everything again, they can then accept your claim with the new information or deny it.
At this point, you can file a lawsuit against the company if they reject your appeal.
Many attorneys are afraid of ERISA cases. That is because the federal courts review the claim denial like an appeal instead of a new case. They may uphold the denial even if they believe that the insurance company made a mistake in denying it. However, we at Dyson Law PLLC actively take on ERISA cases and work to provide favorable results for our clients.
The primary case that explains the Court’s role is:
Williams v. BellSouth Telecommunications, Inc., 373 F. 3d 1132 (11th Cir. 2004) https://scholar.google.com/scholar_case?case=5809781160529832505&q=373+F.+3d+1132&hl=en&as_sdt=40003 These are the steps that a Court takes in making a decision:
“(1) Apply the de novo standard to determine whether the claim administrator’s benefits-denial decision is “wrong” (i.e., the Court disagrees with the administrator’s decision); if it is not, then end the inquiry and affirm the decision.
(2) If the administrator’s decision in fact is “de novo wrong,” then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision.
(3) If the administrator’s decision is “de novo wrong” and he was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard).
(4) If no reasonable grounds exist, then end the inquiry and reverse the administrator’s decision; if reasonable grounds do exist, then determine if he operated under a conflict of interest.
(5) If there is no conflict, then end the inquiry and affirm the decision.
(6) If there is a conflict of interest, then apply heightened arbitrary and capricious review to the decision to affirm or deny it.”
As you can see, the lawsuit focuses on the process of evaluating the claim; the actual decision does not play a large role. The decision could be wrong, and you would still lose. That is why experience counts when you look for a private disability attorney.
Private Disability cases.
If you have a private disability policy that you bought yourself, it is not controlled by ERISA. There are three significant differences between private disability insurance and ERISA. First, you get a jury trial. Next, if the jury determines that the insurance company’s decision is wrong, you win. Finally, the evidence is much broader. It is less focused on the process, and it boils down to whether you are disabled or not.
Government disability cases.
We, at Dyson Law PLLC, work with attorneys that handle government disability cases. Often, there is an overlap, and we work together to get favorable results for our client.
Seek legal help for Palm Beach County Private Disability Claims
You certainly should seek legal help from a Palm Beach County private disability insurance attorney upon denial of coverage. We, at Dyson Law PLLC, hear them and the reasons for rejections. Why risk it alone? You will need to gather much documentation, and you might not even realize or understand what everything means. Some of these documents are:
- Medical records
- Statements by physicians that treated you
- Statements by employers
- Vocational Expert statements
- Footage of the disability, photos, and videos
- Third-party sworn witness statements
- And more!
Be sure you have everything documented.
By having the appropriate evidence that these insurance companies expect, you are less at risk of getting denied. Getting the appeal done correctly means that you can start your road to recovery without worry.
Dyson Law PLLC, Delray Beach, private disability insurance lawyers, are there to help you appeal. This is the best way to get your disability approved and you to get your life back.
Find a Florida private disability insurance lawyer that offers individual and personalized assistance with your insurance claim. No two cases are the same, so it is essential that you receive one-on-one care. We, at Dyson Law PLLC, believe that it is vital that you have a relationship with your attorney that will be able to understand your current situation fully. It is far easier to do this right the first time and get approved than to go through the process of having it looked at again in litigation. Often having an attorney means that this process will go far smoother than without a lawyer. These events could affect you for the rest of your life. Be sure that you get the help that you need.
We will go over your case with you.
If you are looking for professionals that can get your claim approved, you have come to the right place. We, at Dyson Law PLLC, have helped people through this extremely frustrating path. We take the time to get to know and understand our client’s medical conditions.
This allows us to express that to the insurance company. Our job is to go over the claim and ensure that you have everything they need or will ask for and get your benefits. When you have been denied, we are here to help.
When looking for a Florida private disability insurance lawyer, you need to go with someone that you know can get the job done. You need dependability, honesty, and integrity. It is important that you get an attorney who will listen to you and work with you to get you the results you need. Not having disability pay means that you are out of any income. It can be scary and stressful, and you are not in a mindset to take on such a process on your own. Not a problem. We, at Dyson Law PLLC, are here to assist you and to look into your claim. We will gather all the evidence that you need.
Let’s get started on your disability claim today!
Give us a call at 561-903-4542, and let’s get started on your road to recovery. You didn’t ask to be sick or injured, and it’s time that someone pays you to help with the pile of bills. Disability insurance is there for people like you that are sick and injured.
Take your time to find the right attorney for the job. Be sure that they are attentive to your needs and there to help you. We, at Dyson Law PLLC, work with people in your position all the time, and we can work with you as well.
Some ins and outs come with being a Palm Beach County Private disability insurance lawyer, which you can see from above. Many laws protect both you and the insurance company. The system is flawed in many ways, but we can go over your case and let you know what we feel would be the best course of action.
Let’s get started on getting you the compensation you need today. Call an experienced attorney now at 561-903-4542.