Claimants going through this process for the first time can be overwhelmed by its complexity. Here are some of the more frequently asked questions about the process.
 

Most policies require that "proof of loss" be provided shortly after a claim occurs (typically 60 to 90 days). Often times, if notice is provided later, or if a claimant seeks to back date a claim for partial disability benefits, the insurer will take issue with such notice. However, we often work through such issues with the insurers.

Challenging a decision reached by an insurer, where the insurer merely adopts your own doctor’s opinions, is extremely difficult.

Working closely with the physician in the claim process can be the difference in the claim's success or failure. Challenging a decision reached by an insurer, where the insurer merely adopts your own doctor’s opinions is extremely difficult.

Only as much as is necessary to support the claim. We take the cynical view that the insurer is seeking information to be utilized to deny or terminate benefits.

Thus, we are careful in providing responses to informational requests from the insurer. Even with that said, an insurer is always entitled to information about your occupation and, in partial disability or residual disability cases, is often entitled to financial information.

Usually, if you are unable to perform the substantial and material duties of your occupation, you do not need to suffer a loss of income in order to qualify for disability benefits.

Under many of these same policies, if you are only residually disabled, as opposed to totally disabled, then you must generally suffer a percentage loss of pre-disability income as defined in the policy.

Where the claim is total disability, the eligibility for benefits is determined by a loss of ability to perform work duties.

Where the claim is residual, eligibility for benefits is income related as well.

Group disability income policies governed by ERISA have an internal appeals process when an adverse decision has been made on your claim. If an appeal determination is unfavorable to you, and you have exhausted your administrative remedies, you may proceed to the appropriate court having jurisdiction of your claim.

If you do have a group policy governed by ERISA, it is extremely important to provide a powerful and persuasive appeal of the claim, since in court you will be limited to that record that was before the insurer.

Private policies of insurance do not require internal appeals, and you can pursue litigation or other dispute resolution mechanisms immediately. We often work on resolving disputed claims with insurers prior to litigation. However, we will aggressively pursue litigation on behalf of aggrieved policyholders throughout the country.