In this article, you can discover:
A claim can be denied for many reasons…
Perhaps the medical evidence is insufficient, or the condition does not meet the criteria for disability. Alternatively, the claimant’s physician may not agree that the claimant is disabled or that their medical condition prevents them from working.
In some cases, a pre-existing exclusion in the policy may apply. Or, the insurance company may determine that the claimant can perform another occupation. These are just some of the reasons why a claim might be denied.
You need a lawyer for both filing or appealing because you’re not on a level playing field against an insurance company. The adjusters are not out there to look out for your best interest. Instead, they’re looking out for the insurance company, their employer.
You need someone with experience looking out for your best interest, especially when you’re at the appeal phase, because that might be your last chance to make the argument before filing a lawsuit.
There is one main factor that will determine whether or not you can receive long-term disability benefits. This is the definition of disabled in your policy and whether or not you meet that definition.
Most policies have two definitions of disability – the initial determination, known as the “own occupation period”, and the “any occupation” period.
During your “own occupation” period, you would be considered disabled only if you could not perform the specific duties of your job. After that, the “any occupation” period would apply, which generally means that you would need to be unable to work to receive benefits.
Your ability to receive continued benefits after switching to any occupation period in your policy will depend on whether you cannot perform any occupation as defined by your policy.
So, for example, you would not be considered disabled under the terms of the policy if you can still perform other occupations.
The insurance carrier cannot access your medical records without your consent. This means they will not be able to review your claim unless you provide them with the necessary information. By not consenting, you are limiting their ability to obtain the records they need.
Insurance companies have a duty to act in good faith when handling claims. This means that they must investigate and process claims fairly and timely. Failure to do so may be considered bad faith insurance practices.
For example, an insurance company may be guilty of bad faith insurance practices if it unreasonably delays payment on a valid claim, ignores evidence that would support the claim, or only looks for evidence that would deny the claim.
Consumers who believe their insurance company has acted in bad faith may be able to file a lawsuit to recover damages.
It is important to follow the terms of your disability plan. Generally, this will require appealing a denial before being able to file a lawsuit. Without going through this process, your chances of successfully pursuing your claim are slim.
There are some important things to keep in mind when it comes to filing for long-term disability benefits. For example, you may not be able to start over unless you have returned to work. So, if you stop working, file a claim for benefits, and it is denied, you will need to appeal the denial.
Unless you return to work, you will not be able to file a new claim. In other words, you would need to have gone back to work to be covered under the policy again before being able to file another claim.
With the guidance of a skilled attorney for Long-Term Disability Insurance Law, you can have the peace of mind that comes with knowing that we’ll make it look easy.
For more information on Long-Term Disability Insurance Law in Florida, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (352) 577-7746 today.
