What to do if your claim is denied?
The appropriate steps depend on the type of long-term disability insurance coverage that is at issue. If the policy was provided by a private employer as a benefit of employment, the policy is probably part of a group plan which typically is covered by a law known as ERISA. This federal law imposes very specific procedures applicable to appeals. An administrative appeal must be filed under ERISA. The appeal is very important. The evidence that will be used in any subsequent litigation will usually be limited to the record established during the appeal. If the denial is upheld at the conclusion of the administrative process, then a lawsuit can be filed.
Policyholders who have purchased a long-term disability insurance policy outside the employment relationship or obtained their policy as a government employee are not subject to ERISA. The requirement that you exhaust administrative appeals before filing a lawsuit does not apply in these cases.
Do you need to attend an "Independent" Medical Exam?
Generally, long-term disability insurance policies require policyholders to submit to an independent medical examination (IME). In reality, these medical evaluations do not remotely resemble anything close to “independent.” These physicians are chosen by and paid by the insurance company.
The complex legal framework of ERISA makes it extremely risky for an insured to pursue an ERISA disability claim without legal representation.
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].