Long term disability insurance is designed to provide the necessary income to cover medical expenses and lost wages when someone becomes disabled and is no longer able to work. However, disability insurance claims are sometimes denied, leaving the injured worker with little to no income. There are steps that can be taken to appeal a long term disability insurance claim denial and the necessary actions to take depend on whether or not the policy is governed by the Employee Retirement Income Security Act of 1976 (ERISA). If you have been denied long term disability insurance benefits, you need to know how to approach the appeals process.
Most individual (non-group) long term disability insurance polices are not governed by the ERISA. If your plan does not fall under ERISA, you may be able to file a lawsuit without exhausting your administrative remedies. On the other hand, if your policy falls under the ERISA, you will be required to follow all of the appeal procedures offered by your disability insurance provider before filing a lawsuit. A lawsuit cannot be filed under an insurance policy governed under ERISA unless all of these procedures have been exhausted.
Individual long term disability insurance policies, those not covered by ERISA, are governed by the statutory and common law of the state in which the policy is issued. Each insurance policy should outline the appeals process for disputing a long term disability insurance claim denial. If your insurer has a specific appeals process, you may be required to abide by those rules.
If you have been denied long term disability insurance benefits, your insurer should explain the basis for the denial in writing. An experienced long term disability insurance claims lawyer should be consulted.
You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].