You never know when you could be injured in a car accident or come down with a serious illness. For this reason, many people purchase long-term disability insurance policies to supplement their income in the event of a serious illness or injury that keeps them out of work. Unfortunately, even those who prepare for this eventuality by purchasing a policy have their claims denied regularly. While claimants who have had their claims denied can appeal them, the process that they are required to go through will depend on whether they purchased their policy directly from a private insurer or broker or whether the benefits are part of an employer-sponsored benefits plan. The appeals process can be daunting, so if your claim was recently denied and you have questions or concerns about filing an appeal, it is crucial to obtain the advice of a skilled long-term disability lawyer who can explain your options.
If a person obtained a long-term disability insurance policy from a private insurer or broker and his or her claim was later denied, the policyholder may be able to file a claim for reconsideration directly with a court. This may require the claimant to provide additional medical documentation to the insurer or fix any clerical problems in the original claim application. If a claimant believes that the insurer denied the claim as a result of bad faith or breach of contract, he or she can sue for punitive damages in addition to benefits.
Private employers who choose to offer benefit plans to their employees must comply with rules put in place by the Employee Retirement Income Security Act (ERISA). These rules also apply to the appeals process for denied claims. For instance, a plan’s administrators must respond to an appeal within 45 days of receiving it. However, ERISA also restricts employees and beneficiaries. For example, if an employee’s claim is denied, he or she cannot go directly to a state court to dispute the decision. Instead, the employee will need to exhaust the administrative process required by ERISA and file an appeal within 180 days of receiving the denial. When reviewing the claim, the insurer may request additional information, including:
If a claim is denied a second time, the claimant can file a lawsuit in federal court. However, unlike denials by private insurers, plaintiffs appealing a claim denied under an ERISA-approved plan cannot seek bad faith or punitive damages in court, but will be restricted to suing for the benefits they are owed.
At Michael Bartolic, LLP, we understand how frustrating it can be to have a legitimate long-term disability claim denied and so take great pains to aggressively represent our clients throughout the appeals process. Whether your were denied benefits under an employer-sponsored ERISA plan or by a private insurer, please contact our legal team today at (312) 635-1600 to schedule a free one-on-one case evaluation with a skilled long-term disability attorney today.