Have you recently been injured and are considering filing for long-term disability? Have you already filed for disability and had your claim denied by the insurance company? If so and your disability insurance plan is governed by ERISA, it’s helpful to know the most important parts of filing and/or appealing an ERISA long-term disability claim or denial in order to decide whether representation by an attorney is something you need.
In the midst of everything associated with being injured and needing to file for long-term disability, many find that fighting the insurance company is something they’d rather have an attorney deal with while they focus on healing. But that's just the beginning of it when it comes to ERISA long-term disability claims.
The following three items are significant factors which determine whether your claim is ultimately approved or denied. If you’re unable or unsure if you will be able to successfully acquire and compile these items, it’s important that you reach out to an attorney who can help you before your filing window ends.
Should you have any questions or concerns about anything, the attorneys at Donahoe Kearney are standing by and ready to help!
Insurers or administrators considering your long-term disability claim rely on an administrative record when reaching a decision about whether to approve or deny your claim. The administrative record will usually include medical records, medical reports, bills, and correspondences. When preparing an administrative record, it’s important that all aspects of your record remain consistent throughout the record itself and with any secondary documents referenced.
Inconsistencies in an administrative record are a red flag to those looking to deny your claim and often lead to further scrutiny of your case by the insurance company or by a court hearing your case.
Communicating with your Doctor
So many who file for long-term disability have their case denied simply because they were unable to communicate their needs to their doctor in a way that will be understood and digested by the insurance company. In a case involving an accident or injury that leads to someone filing for long-term disability, the duty of a healthcare provider is primarily one of immediate medical attention. Even the best healthcare professionals will not necessarily be focused on how you will provide for yourself after you leave their care. For this reason, it’s important that you have an attorney who understands the bigger picture and can give you necessary information to communicate to your healthcare provider or in some cases, communicate with your healthcare provider on your behalf.
A great example of properly communicating with your doctor arises when compiling the administrative record previously mentioned. An attorney who knows what the insurance company or court is looking for will be able to request the proper information from the beginning, when they first review your claim. You don’t want to have your claim denied because the clock ran out while you were waiting on a doctor’s office to send over the correct paperwork.
Timelines and Limitations
In addition to the previous two items, submitting a long-term disability claim also involves timelines, deadlines, and limitations. The number of days you have to file your appeal is an area where many run into serious difficulty. Identifying deadlines and not misinterpreting any of them is where an experienced attorney can really help.
The approval or denial of your disability claim is something that will have a lasting effect on your entire life after a major accident, injury or illness. Hiring an experienced attorney like the attorneys at Donahoe Kearney is one of the best things you can do for yourself on your road to recovery. When dealing with insurance companies that have every reason to deny your claim, having experience on your side is invaluable.
If you want to error on the side of safety, we will review your Long-Term Disability plan for you at a deeply discounted rate - so you can have peace of mind knowing whether or not your plan will be difficult to actually administrate if you need it. Chances are high, that it will be, and you should be informed about that.
Don’t let the clock run out; reach out to one of our attorneys today and we’ll get to work!