Appeals Process for Individual Long-Term Disability Insurance

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 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 benefits, you need to know how to approach the appeals process.

The appeals process is different for ERISA plans and non-ERISA plans.  Most individual long-term disability insurance polices are not governed by the ERISA.  If your plan is not under the ERISA, you may be able to file a lawsuit without exhausting your administrative remedies.  On the other hand, if your policy is 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 can not be filed for a ERISA plan unless all of these procedures have been pursued.  It would be wise to hire a Florida disability insurance claims attorney who can help you navigate through the complex process.

Appealing an Individual Long-Term Disability Claim
Individual long-term disability plans, those not covered by the ERISA, are governed by statutory and common law of the state in which the policy is issued.  Each policy should outline the appeals process for disputing long-term disability claim denials.  If your insurer has a specific appeals process, you need to abide by those rules.  When you sign a contract for long-term disability insurance, you are agreeing to the terms, which include the appeals process.

If you have been denied long-term disability benefits, your insurer should have explained the reason for denial in writing.   You can also contact the claims manager by drafting a letter that requests the exact reason for the claim denial.  Some insurance companies are not cooperative and in that circumstance, you can contact the consumer complaint division of the Florida insurance department.  The department investigator may contact your insurance company to get their side of the story and the information will be forwarded to you.

Legal Representation for a Long-Term Disability Insurance Denial
If a resolution is not reached with the insurance company, it may be time to pursue a lawsuit.  An experienced Florida long-term disability claims lawyer can represent you in court.  J.P. Gonzalez-Sirgo represents individuals who have been denied long-term disability benefits and can help you.  Call 305-461-1095 in Miami Dade County or toll free at 1-866-71-CLAIM.