Long term disability due either to illness or injury can have a devastating effect on the financial life of a struggling family. Quite too often the disability benefit applied for by many individuals are turned down by insurance providers. The usual reason for such denial, as stated on the website of Scudder & Hedrick, P.L.L.C., is strictly technical, though, and not because of ineligibility; that is, improper filing of application or missing a signature or skipping a box when filling out an application paper – these errors sometimes happen because disability insurance policies are long and complex documents that can confuse applicants.
However, there are also reported instances when applicants are judged not qualified or, if approved, are awarded small payments. If long term benefits are meant to compensate for salary losses, then being awarded a small amount would never suffice for medical treatment alone, let alone the family’s daily expenses.
Many insurance providers resort to finding faults in applications aggressively and then deny claims or award small benefits to ensure increase in their profit. Besides using the guise of technical or paperwork issues, these providers also resort to other tactics to make denials appear legitimate, tactics like, misclassification of injuries, undue termination of the policy and delay in the approval and/or release of benefit.
Legal experts call denials of benefit as “insurance bad faith,” which is a breach of the contract that providers, themselves, made and which they signed with the policy holder. If an insurance company, though, denies any long term disability benefits claim, then the applicant must be allowed to a full and fair examination of the denied claim, as well as to appeal the decision.
An appeal is a formal petition that asks for a re-assessment of an unfavorable decision (like a denial, termination or reduction of benefits) made by an insurer. To avoid losing an appeal, some important factors that claimants ought to consider are:
- Preparation of relevant documents like medical record, medical expert opinion, letters from employer, medical abstract and photographs
- Awareness and readiness to argue against an insurer’s inadequate in-house medical review, misrepresentation or misuse of evidence
- Filing the appeal before the set deadline
Equally important as those above is having a highly-skilled and determined legal counsel who will represent you and fight for your rights throughout the appeals process. A less qualified lawyer may cost applicants the long term disability appeals they have worked hard to prepare for.