The Insurance Policy Is Written by the Insurance Company. If you have ever tried to parse the language of a long term disability insurance policy, you were probably greeted by dense and incomprehensible language. This is because the disability insurance policy was written by a team of insurance company lawyers. Thereafter, the policy was rewritten again and again over many years to limit the liability of the insurance company in increasingly subtle ways. Insurance policies are contracts of adhesions. Insureds don't get to negotiate the terms of these policies. One challenege that insureds have to overcome during the claims process is being able to get a reasonable understanding of the policy language and its terms, conditions, and benefits.
Insurers Provide Policyholders with “Generic” Letters of Denial. Another challenge is understanding the basis of a claim denial. Denial letters are often full of legalese and quotes of policy language but short on facts. This does not guide an insured to know what is needed to resolve the claims dispute. In the denial letter, the insurer will typically indicate that the insured failed to provide sufficient information or evidence that the insured is entitled to coverage under the policy. The letter will then broadly suggest that the insured submit further evidence, such as medical tests, doctor reports, supplemental reports and other documentation without specifying exactly what is needed to obtain claim approval.
Your Employer Has No Incentive to Help. Many employees try to get the HR department at work to assist them with the claim. Beyong providing the employee with claims forms and the 800 number to the insurance company, HR departments rarely get meaningfully involved in the claim. Employers have no incentive to get employees to qualify for long term disability insurance claims payments. As such, getting your employer to assist in the claim is a challenge.
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].