Assurity Long-Term Disability Denial : Understanding the Assurity Claims Process and Your Rights

Assurity, one of the leading providers of long-term disability insurance, offers millions of Americans the opportunity to safeguard their financial well-being in the event they can no longer fulfill the duties required by their job. Unfortunately, a significant number of policyholders face the frustration of having their claims denied, often for reasons that seem unjustified. At Robinson & Warncke, we are dedicated to safeguarding your investment in disability insurance and ensuring that your policy pays out when you need it. In this article, we will delve into the intricacies of Assurity long-term disability denial, provide insights into the claims process, and offer guidance on seeking justice.

The first step to protecting your rights is gaining a clear understanding of how the claims process works. Insurance companies are notorious for denying valid claims, and while some denials may be based on policy exclusions or legitimate reasons, others may leave policyholders puzzled and uncertain. To avoid unnecessary hardships, it is essential to discern which category your case falls into. Some individuals may find themselves battling against a claim that simply cannot be satisfied, while others may abandon their claim even when it can be proven. At Robinson & Warncke, we can analyze your claim and provide guidance on whether pursuing it is worthwhile.

Assurity offers both short-term and long-term disability policies. Short-term policies typically provide benefits for a period ranging from three months to one year, while long-term policies offer benefits to at least age 65. However, it is crucial to note that there is often an elimination period. Many policies stipulate that after twenty-four months of benefits, you must establish that you are unable to perform any job, rather than just your current occupation, in order to continue receiving benefits.  This is a crucial milestone in the life of every claim, and legitimate claims are often denied at this point.  At Robinson Warncke we prefer to be proactive about proving “any occupation” disability before the insurer has a chance to deny benefits.  If your “any occupation” claim has already been denied, we urge you to contact us for a free consultation before you try to appeal on your own.

Understanding the Definition of Disability

As a policyholder, comprehending the definition of disability outlined in your policy is of utmost importance. Insurers often employ a much narrower definition than what an average person would consider. Some policies deem you disabled if you can no longer fulfill the duties of your current job, while others require you to be unable to perform any job for which you are qualified and that provides a similar standard of living. Many policies provide a certain period of coverage for your own occupation and then transition to any occupation coverage.

To navigate the complexities of policy language, it is advisable to consult an experienced disability attorney. They can meticulously examine the fine print of your policy and help you decide if contesting a denial is in your best interest.

Why Assurity Denies Claims

The Profit Motive Behind Denials

It is no secret that insurance companies generate revenue by denying claims. What often goes unnoticed is their financial gain from delaying claims. Leading insurers, including Assurity, have made a habit of frustrating policyholders with unnecessary bureaucracy. If you believe that Assurity has unfairly denied or delayed your claim, it is crucial to seek the assistance of a disability lawyer in Atlanta, GA immediately.

Common Red Flags

Several indicators suggest that your claim is not being processed fairly. These red flags include:

  • Requests for independent medical examinations (IMEs) conducted by underqualified medical professionals.
  • Multiple requests for duplicate information.
  • Excessive delays in decision-making, exceeding the time limits allowed by law.
  • Failure to consider all the evidence you submit.
  • Attempts to settle the claim for an amount lower than its true value.
  • Unwillingness to render a timely decision.
  • Downplaying medical evidence that supports your claim.

The reason these tactics work is that many policyholders do not fight back. Unless you possess expertise in medicine and disability law, you may be unaware that Assurity has violated the law or best practices in the insurance industry. Long-term disability policies involve substantial payouts over several years. If these tactics succeed even 10% of the time, it translates into significant financial gains for the company.

Assurity and Post-April, 2018 Group (ERISA) Disability Claims – Understanding ERISA and Its Impact.

If your Assurity coverage was obtained as an employee benefit, it is likely governed by a federal law called the Employee Retirement Income Security Act (ERISA). This complex law, enacted by Congress and regulated by the Department of Labor, has its disputes litigated in federal court. While ERISA presents procedural challenges for claimants, it also imposes legal duties on insurers like Assurity to ensure fairness and promptness throughout the claims process.

ERISA, enacted in 1974, has undergone multiple revisions to prohibit insurers from engaging in unscrupulous claims practices. The most recent revision, applicable to claims filed after April 1, 2018, offers additional legal advantages to claimants. Insurer compliance with these regulations plays a crucial role in the outcome of many cases.

Key Obligations Imposed on Insurers

Insurers must fulfill various regulatory obligations, failure to comply with which can result in severe legal consequences. These obligations include:

  • Adhering to specific time deadlines at every stage of the claims and appeals process to ensure promptness.
  • Providing a clear explanation for adverse decisions and clearly indicating missing information in plain language.
  • Affording claimants the opportunity to obtain a complete copy of their claim file, including internal notes, medical reports, and vocational consultant reports.
  • Ensuring that all evidence and comments submitted by the claimant are considered during the appeal process without cherry-picking.
  • Maintaining safeguards to guarantee competent and impartial/fair medical and other reviews.
  • Sharing all new consultant reports during the appeal process, allowing claimants and their doctors to respond in a timely manner.
  • Evaluating an insurer’s compliance with these legal obligations requires professional expertise. At Robinson & Warncke, we focus on scrutinizing insurer actions to identify any violations of these obligations. Many clients have been unaware of Assurity’s breach of its legal duties until we reviewed their files. If you harbor any concerns regarding the handling of your claim, it is best to seek a free consultation with our experienced team.

Unfair Assurity Long-Term Disability Denial Tactics

While it is customary for insurance companies to request additional information following an initial claim, disability insurers sometimes provide ambiguous or misleading information regarding the requirements for completing the claims process. Furthermore, “independent” medical examiners often provide questionable reasons for downplaying illnesses and injuries leading to the denial of legitimate claims. Lastly, insurers often fail to consider the unique duties of occupations when denying claims. In other words, they may assert that you can still perform your job despite your disability based on an inaccurate understanding of the physical, mental and/or emotional demands of your occupation.

In the past, Assurity has employed the following tactics:

  • Utilizing in-house nursing staff to review and deny complex medical claims.
  • Seeking assistance from doctors who primarily serve insurance companies.
  • Supplying doctors with incomplete paperwork, hindering them from providing accurate and comprehensive opinions on the claimant.

Assurity’s Use of Surveillance to Deny Disability Claims

Assurity’s substantial resources afford them the ability to outspend anyone attempting to make a claim on their policy. Large insurance companies like Assurity are known to conduct background checks on claimants, scour their social media accounts, and even deploy private investigators to capture compromising photographs that can be used to reject claims.

We Can Help You Appeal a Denial

Assurity counts on the fact that many policyholders will not challenge a denial. By persuading even a small percentage of claimants to give up before exhausting their appeals, the company saves thousands of dollars. Shockingly, the number of policyholders who abandon their claims upon denial ranges from 25% to 50%. Assurity assumes that those who persist in their fight genuinely require disability coverage.

Having an attorney manage your claim sends a strong message to Assurity that you are serious about obtaining the benefits you deserve. If your claim is delayed or denied, we have the ability to file a motion and establish that Assurity is acting in bad faith. Our objective is to ensure that your claim is processed honestly, and that the insurer fulfills its end of the bargain.

We meticulously review your medical records, analyze every aspect of the policy, and ensure that the courts understand the nature of your work duties. By constructing a compelling case file, we can challenge Assurity’s denials effectively.

To delve deeper into the appeals process, we encourage you to read our article titled “Should I Handle My Own Appeal?

In the face of Assurity long-term disability denial, it is imperative to take proactive steps to protect your rights and seek justice. Understanding the claims process, recognizing unfair denial tactics, and harnessing the legal advantages provided by ERISA are crucial in this endeavor. At Robinson & Warncke, we are committed to guiding you through the complexities of long-term disability claims, ensuring your investment is safeguarded, and fighting for the benefits you deserve. Contact our Atlanta, GA disability lawyers today for a free consultation and take the first step toward securing your future.