You have recently applied for your long-term disability, but your claim was summarily denied! Well…it couldn’t get worse, right?
Unfortunately, disability denials are too common. In fact, there’s a good chance you’ll be stuck in one during your long-term disability journey.
But the silver lining here is that you can overcome them, with help.
First things first: You need to Understand Your Denial Letter
Your denial letter will state why your claim has been denied. It’s possible that the terms in the letter make it hard to understand beyond the basic concept (denial). If you’re having a hard time making heads or tails of it, reach out to us, and we’ll help you start working on a plan of attack to overcome the decision.
Fundamentally, the insurance provider believes you do not qualify for long-term disability benefits. This is often because they claim your medical evidence is unsubstantiated or otherwise doesn’t fully demonstrate that your injuries or illnesses bar you from being able to work. In fact, they may go so far as to say that you can work and should be able to hold down a job.
Of course, they don’t know you from Adam, so how could they say that? Sometimes, they say it, to see how you will respond.
ERISA Protects a Process, But Not Necessarily You…
Why would an insurance company deny benefits they know you deserve? Simply put, there is very little incentive for them to say, “Yes.” And a lot of incentive for them to say, “No.” If they say no and you do not appeal, they never have to pay out the benefits on your claim. Moreover, if you ultimately prevail, they’ll be out little more than what they would have originally paid out to you in the first place. So, dollars and cents here… Say No and save thousands, or Say No and lose nothing, or say Yes and pay out thousands. It’s a sick type of arithmetic, but you gotta wonder why else would denial rates be so high?
ERISA Speeds Up the Process
While ERISA lays out a process for administering disability claims, and in so doing also somewhat creates the scenario that we just talked about (wherein the incentive for the insurance provider is to deny at first), it does offer grace in that it formally speeds up the appeal process compared to other types of disability claims.
Unlike Social Security disability or VA service-connected disability, whose claims can take up to 1 year and appeals can take more than two years (3 total years), your ERISA regulated long-term disability claim and appeal should be over within months, at most. In the worst case scenario you will end up suing the insurance provider for the benefits you should rightfully be getting, but even then, the timeline is not likely to last as long as an SSDI or VA appeal!
Speed Up Your Appeal By Getting Out of Your Own Way
Do you know the best way to take advantage of every opportunity ERISA will provide for your appeal? Get help. An experienced ERISA disability lawyer specializes in streamlining and stacking your appeal. You will not miss deadlines, you will return fully developed arguments to your insurance provider, and you will even hold their feet to the fire for their mistakes when they make them. In short, you can turn the tables. You already know they are hoping you don’t appeal. They also anticipate being able to beat you in an appeal because many others like you do not hire professional help until it’s too late.
Do something they haven’t game planned, and penciled in their calculations, hire a disability attorney to take the fight right back to them.
We’re here to help you today, reach out to us.