How A Disability Insurance Attorney Can Assist In The Administration Or Appeal Of A Disability Claim

Dealing with an insurance company at any stage of the disability claims process can be complicated, frustrating, time consuming and confusing.  Whether you are applying for disability benefits, waiting for a claim determination, on claim, appealing a denial or termination of benefits, or considering a lawsuit, utilizing the assistance of a knowledgeable attorney can prove quite beneficial.  Attorneys familiar with this area of the law know what information needs to be provided for a successful claim and can competently navigate the claims process at any stage.  More importantly, hiring an Disability Insurance Law Group can help the insured avoid mistakes that my ultimately result in a claim denial, the termination of benefits, or the ability to prevail should the claim have to be litigated in court. 

The application process can be complicated as it requires the insured to prepare a written application; provide proof of claim and documents in response to aw seemingly endless request for information; answer the claim adjuster’s questions and/or attend an interview; obtain sufficient information and support from the attending physician; possibly attend a medical evaluation of the insurer’s choosing and/or respond to issues raised by surveillance. Without guidance, an insured can unintentionally provide the insurance company with the means to delay or deny a claim.

One of the most important aspects of a claim is the attending physician’s form. When not completed properly this form is often used by insurance companies to deny claims. An experienced attorney will work directly with the client’s treating physician(s) to help them understand how the term “disabled” is defined under their patient’s particular policy and the specific information being sought by the carrier.

At some point during the administration of the claim, most insurance companies will request an independent medical examinations (IME) or functional capacity examinations (FCE) to better understand the Insured’s disability. The doctor or physical therapist performing the examination is hired by the insurance carrier and is not truly independent. A skilled attorney will make sure that the insured has a solid understanding of what will occur at the examination; that the examining physician has the information necessary to truly understand the insured’s disability; and that the insured is properly represented at the examination.

Successfully appealing a denied claim can be difficult or impossible without the help of a knowledgeable lawyer. While the insurance carrier may promise a “full and fair review” of the claim; it is often up to the Insured to provide them with the information, documents and medical support necessary to overturn a denial. For persons with policies governed by ERISA, failure to present a complete appeal may result in an irreversible claim denial. Those individuals with private, non ERISA policies can also significantly impede their chance to successfully appeal a denial if they do not proceed in a timely fashion and fail to perform all of their contractually required duties.

There are hundreds of different policies on the market. Securing the disability benefits to which you are entitled under your policy depends on a clear understanding of the policy’s terms and the obligations of both the insured and the insurance company. Thus, your attorney should be willing and able to answer the following questions about your policy: When must I file my claim for disability insurance benefits?

• What information should I provide my insurance carrier when applying for benefits?
• What role does my physician play in my claim for disability?
• Am I required to disclose all of my financial information?
• Under the terms of my policy, am I totally or partially disabled?
• Am I required to submit to a field interview or provide a statement to my disability insurance company?
• Must I submit to an Independent Medical Examination, chosen by my Insurance Company?
• How much information should I give my disability income carrier?
• How much time should the carrier have to investigate my claim?
• Can I collect benefits while the carrier is investigating my claim?
• Can I collect social security benefits or workman’s compensation while collecting disability income benefits?
• What if my claim is denied or unreasonably delayed by my disability insurance company?
• What are my rights and obligations under my policy in terms of submitting proof of my disability to my insurance company?
• What does the “appropriate care” provision of my policy mean?
• Do I have to undergo surgery or a particular procedure to remain eligible for benefits under my policy?
• What is the disability income carrier’s internal appeal procedure?
• In the event of a denial by my disability income company, how does the litigation process work?
• How are attorney’s fees charged?
• Under what circumstances will my disability income carrier pay my attorney’s fees?

The attorneys at Disability Insurance Law Group have extensive experience representing disability income claimants and are happy to discuss these questions and any other important issues during our free consultation. We represent clients throughout the nation and have attorneys that are able to practice in numerous states. Contact us today at www.dilawgroup.com or (954)-989-9000 for the answers and experienced legal help you need.