It is a common scenario that insurance companies that have sold you a disability policy attempt to terminate benefits by claiming that the disability is no longer present or severe enough to prevent employment.
This is most often between two and four years after receiving benefits depending on the type of language in your contract. Most disability insurance policies cover a period of time ranging from two to four years after which the definition of total disability changes.
The definition is usually narrowed, which is generally bad for the policyholder. This change may take the form of increasing the number of occupations that must be considered before determining whether you are disabled, or narrowing the requirements to meet continuing disability.
Additionally, disability policies include the right of the insurance company to obtain your medical records and periodically examine you for the purposes of determining whether you are still disabled.
If you and your doctors know that you are still unable to work, then a prompt and thorough response should be made when an insurance company notifies you of its intent to limit or terminate your benefits under your disability policy. .
Typically, the insurer will notify you in writing and give you its reasons for eliminating or terminating your benefits. This letter also includes important information about how to fight the insurance company’s decision. First, the letter should give you the necessary instructions on how to appeal the decision.
Most disability policies have provisions that require an appeal process before a claim can be filed. Whether or not these particular complaints should be pursued is a legal matter that can only be determined after knowing which laws are applicable to your particular insurance contract. However, it is generally advisable to follow the appeal process as it is your first opportunity to change the decision.
The letters should also advise you of the policy terms, conditions or exclusions that the insurance company identifies as part of the agreement that gives it the right to terminate or eliminate your benefits.
In particular, insurance companies do not always interpret these provisions correctly and therefore they must be reviewed closely to determine whether the insurance company is relying on the correct language, omitting relevant language, or misinterpreting the language. Finally, the letter will also list the specific reasons the insurance company claims you do not meet the disability criteria. This information constitutes the facts upon which the insurance company relies in making their determination and should be the primary focus of your attack.
If you have received such a termination notice or termination letter from your insurance company, it would be prudent for you to seek attorneys knowledgeable in insurance claims disputes. However, if you wish to proceed on your own, you should familiarize yourself with all three elements of the letter above and educate yourself adequately to understand the language of the contract, applicable law, the timing, method and process of appeal, and the factual issues of contested.
To dispute the insurance company’s decision, you must immediately collect medical evidence to support your claim that you are disabled. This information will come from your medical records and the better you are treating doctors. You should contact each of your treating physicians and give them a copy of the insurance company’s termination letter. Ask your doctors, if they still believe you are disabled, to write letters explaining in detail the medical reasons that lead them to conclude that you are disabled. The doctor must also include his opinion that you continue to be disabled in his letter.
You should also write to the company and ask them to give you a copy of your claim file, as well as any documentary evidence they have that supports the facts they relied on in making their decision.
In doing so, you should be aware that insurance companies are subject to laws that have been enacted in each of the 50 states in the United States regarding fair claims practices. Most State Departments of Insurance have adopted specific regulations on how to implement these fair practice claims acts. For example, most states have specific requirements for the time period in which an insurance company must respond, and specific types of information they must provide you. In addition, the common law has developed legal rules that apply to insurance companies.
You must properly prepare your complaint and provide all necessary documentation to the insurer before the specified deadlines.
Your letter should include a statement that you disagree with the insurance company’s decision, as well as your reasons for appealing. This will be based on the medical records and evidence you have received from your doctors, as well as the appropriate contract language and applicable law.
You may also want to contact your state insurance department and file a complaint. If you do, you may want to include a copy of the complaint with your appeal.
Undertaking an appeal of a denial of benefits requires knowledge, skill and determination. If you are unable to meet this challenge on your own, then you should contact an experienced insurance claims dispute attorney to help you with your appeal and if the appeal is denied file a lawsuit on your behalf so that you can get the benefits of the insurance policy you bought and paid for.