Disability insurance is supposed to protect you in the event you are disabled or are unable to work before retirement. Your employer may offer you disability insurance as part of your benefits package, or you may purchase it independently, but in either case you are entitled to the full amount of your benefits should you become disabled.
You purchased the insurance fully expecting its policy terms would be honored, but unfortunately this isn’t always the case. Benefits denials often arise at a time when you are vulnerable and unable to handle such a threat to your financial stability. Insurance companies count on this, and hope you’ll get your benefits elsewhere, such as Social Security or Workers’ Compensation. But when you’ve suffered a disability-causing accident, neither of these sources is enough, and you need the benefits you’re entitled to in order to make ends meet.
Appealing a Denial
Any disability plan maintained by your employer is required by law to maintain an appeal procedure. Before you are allowed to sue for disability benefits, you must appeal. This process can allow your insurance agency to reverse the initial denial, but can also be detrimental to your case. If you do not present strong evidence at this time, it could adversely affect your chance of winning in court. Although the appeal to the insurance company is not a trial or lawsuit per se, we recommend that you seek the advice of a qualified attorney.
When you are denied disability insurance benefits, you must receive the exact reason for your denial in writing, including:
- Specific policy provisions on which the denial is based
- A summary of the plan’s review procedures
- Guidelines or criteria that were referenced when making your denial determination
- A list of documentary evidence the insurance company considers requisite to an acceptance of your claim.
Read your denial carefully, and make sure it includes all of these requirements, as they are mandated by the Employee Retirement Income Security Act (ERISA).
Bring your denial letter to your doctor. He or she should respond to each and every concern and detail mentioned in your denial letter. Get a response from your doctor based on a new examination, if necessary. Gather any and all medical evidence that supports your claim, such as notes, medical records, x-rays, administered medications, etc.
If you have been denied disability insurance benefits, it is possible to win your benefits through an appeal or, if necessary, a trial. The Oklahoma insurance disability lawyers at Carr & Carr are dedicated to making sure you get the disability insurance benefits to which you are entitled. Contact us today to schedule a free evaluation, or call 1-877-392-4878. Our attorneys have offices in Tulsa and Oklahoma City, but we represent clients across Oklahoma.