Ten Frequently Asked Questions Regarding Disability Insurance Coverage Your health coverage is, and should be the highest priority. However, some insurance companies don’t always seem to see your health in the same light. Many insurance providers are very difficult to work with and often deny claims to protect themselves. This can sometimes lead to some clients in having delayed medical provision and further pain. If you have been denied or if you are struggling to get approval for your disability needs, you need seek help and contact an experienced legal representative immediately. Ten Frequently Asked Questions Regarding Disability Insurance Coverage What are the necessary steps in filing a disability claim? If my individual disability insurance claim has been denied, what should my next step be? Should I hire an attorney for the appeals process of my denied disability claim? Why do I need to appeal the denial of my claim? Can I file a lawsuit before I appeal a denial of disability benefits? What can I recover for damages from my insurance company? What does ERISA mean for long-term disability benefits? If I own my company and pay for my health insurance, why does my insurance card have ERISA printed on it? Define the differences between “own occupation” and “any occupation” as it applies to disabilities. Do your attorneys handle disability claims on a contingency basis? 1. What are the necessary steps in filing a disability claim? The first step in filing a disability claim is to contact the agent or broker who sold you or your company the policy. You should quickly receive the claims forms you will need to thoroughly complete. A qualified attorney can be an invaluable asset in properly completing your complex claim’s forms and can prevent a denial based on incomplete information being presented. 2. If my individual disability insurance claim has been denied, what should my next step be? Each individual disability insurance policy has its own governing clauses. Some will require an appeal; others will require another form of filing for reconsideration of your benefits. It is important to have the expertise of an attorney to decipher what is required for you to do if your claim has been denied. The fine print of your policy is most likely difficult to interpret without a legal background. 3. Should I hire an attorney for the appeal’s process of my denied disability claim? While you are not required to hire an attorney to represent you during the appeal of a denied claim, it is highly recommended that you enlist an attorney’s guidance to even the playing field. The insurance company usually has its own attorneys to guide them through an appeal’s process, along with their own medical personnel, vocational specialist, and a number of other claims’ representatives to assist their side of the appeal. If you are dealing with a group policy, it will be imperative to hire an attorney with expert knowledge of the ERISA guidelines. An insurance company will not show you any favors if you choose to represent yourself. They are paying for the expert attorneys, and medical personnel regardless if you have an attorney or not. 4. Why do I need to appeal the denial of my claim? The Employee Retirement Income Security Act of 1974 (ERISA) requires the exhaustion of all administrative remedies prior to filing a lawsuit under a group disability policy. 5. Can I file a lawsuit before I appeal a denial of disability benefits? If you do not file an appeal for your group disability claim denial, you will not have any other recourse to receive the benefits you are owed. ERISA, the Employee Retirement Income Security Act of 1974, will not allow you to file a lawsuit prior to an appeals process. The insurance company should have an established internal appeal’s process that must be followed. If you have an individual plan, you may not need to appeal before filing a lawsuit. The verbiage outlined in your specific policy will determine the best route for you to take in order to recover the maximum amount of benefits. The attorneys at Nolan, Thompson & Leighton, PLC have the expertise you need to determine the most effective way for you to receive the disability benefits you are owed. 6. What can I recover for damages from my insurance company? Each policy will outline the types of damages you are allowed to recover in your disability claim. ERISA governed policies have strict guidelines on what is and is not covered in a disability claim. You may be able to collect interest on past-due benefits under certain circumstances, but ERISA limits the amount of damages you may collect and prevents penalties from being charged to the insurance companies even if they unfairly delay your payout. Policies that are not governed by ERISA may allow for more damages to be covered. Contact Nolan, Thompson & Leighton, PLC to ensure you receive all you are owed. 7. What is ERISA and what does it govern? ERISA stands for the Employee Retirement Income Security Act of 1974. Disability policies obtained through your employer, union or employee organization are just one aspect covered under the regulations of ERISA. Most individual long-term disability policies are not governed by ERISA. The main intent of ERISA was to provide standardized employee benefit plans such as life, health, disability and retirement plans. ERISA was meant to help the employee; however, insurance companies have used the laws to limit what is and what is not covered under these policies. ERISA governed policies have strict guidelines for filing long-term disability claims as well as appealing a denial of a long-term disability claim. You are only given 180 days to appeal a denied claim starting from the date on the letter. You are not required to hire an attorney for your appeal, but a disability attorney can be a huge asset in winning your appeal. In dealing with insurance companies, you will quickly learn they do not have your best interest in mind; they only want to offer the smallest settlement, if any, to realize the largest profit for their company. 8. Are all attorneys familiar with ERISA governed disability claims? Most attorneys do not generally understand the complex regulations of ERISA unless they specialize in this legal arena. It is imperative to enlist the right attorney to ensure your rights are protected if you must appeal a denial of group disability policy claim. Under ERISA, you automatically lose your right to a jury trial and any chance of recovering psychological, emotional or punitive damages. All administrative appeals must be followed in the given time frames prior to filing a lawsuit for damages. An ERISA expert attorney from Nolan, Thompson & Leighton, PLC will be the biggest asset in filing and/or appealing your long-term disability claim. 9. What are the differences between “own occupation” and “any occupation” as it applies to disabilities? An “own occupation,” also known as “your regular occupation,” clause in your disability policy means that disability benefits will be paid if you are unable to complete the tasks and duties of your occupation due to your disability. Many policies define “own occupation” on a national economic level, and not as it necessarily pertains to your specific employer. This type of disability benefit coverage is usually provided for a set number of months. If your disability continues past this predetermined time frame, then you are required to prove you are not able to perform tasks or duties of “any occupation” that you should be able to perform with your work background, education and training in order to continue to receive another type of disability benefits. For clarification of these policies, contact the Nolan, Thompson & Leighton, PLC disability attorneys. 10. Do your attorneys handle disability claims on a contingency basis? Yes. When you face a disability, you typically lose your income and your ability to support yourself and your family. Legal fees would seem unfathomable at this time in your life. Our firm represents disabled clients on a contingency basis meaning you do not pay any attorney fees or legal fees up front, and until we receive a settlement for you. However, we also offer our clients the option of an hourly billing arrangement should that method be preferred. The choice is entirely up to the client. Contact A Legal Representative Nolan, Thompson & Leighton, PLC has helped hundreds of clients in recovering disability benefits and getting their claims approved. We understand insurance plans and the various complex aspects that can often be confusing. We want to know your story and help you in any way that we can. Contact our firm today for a free consultation. If you have any questions or if you wish to discuss this case further, please fill out our online contact form, or call us at 952-405-7171.