Most policies require that “proof of loss” be provided shortly after a claim occurs (typically 60 to 90 days). When notice is provided later than two or three months, or if a claimant seeks to back date a claim for partial disability benefits, the insurer will take issue with such notice. Frankel & Newfield helps disability insurance policy owners resolve this kind of problem frequently, but, generally speaking, the earlier you file, the better.
Working closely with your physician during 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. The partners will work with your doctor to make sure that s/he understands the importance of their role in the claim process and ensure that all documents are prepared correctly.
Only as much as is necessary to support the claim! Based on our long experience representing policy owners, Frankel & Newfield takes the cynical view that the insurer is seeking information to be utilized to deny or terminate benefits. As a result, we are very careful in providing any responses to informational requests from the insurer. However – the disability insurance company is entitled to information about your occupation; and in partial disability or residual disability cases, it is often entitled to financial information. However, the information gathering process is one that needs careful monitoring and control because any and all information can and will be used to deny and delay your benefits.
If you are unable to perform the substantial and material duties of your occupation, under many policies, you do not need to suffer a loss of income in order to qualify for disability benefits. Under many disability insurance policies, if you are only residually or partially disabled, as opposed to totally disabled, then you must generally suffer a percentage loss of pre-disability income as defined in the policy. But where the claim is total disability, the eligibility for benefits is typically determined by a loss of ability to perform work duties. Where the claim is residual, eligibility for benefits is income related as well.
If your disability insurance policy is a benefit from your employer, it is a Group Policy that is usually governed by ERISA, a federal law with very specific rules about appeals. You will need to go through an administrative appeal if your claim has been denied, and you should only do this with the assistance of experienced and aggressive disability insurance lawyers. If and when your appeal is denied, and when you have exhausted your administrative remedies, only then are you allowed to proceed to the appropriate court having jurisdiction of your claim. If you have a Group Policy governed by ERISA, it is extremely important to work with an attorney who understands how to prepare a powerful and persuasive appeal of the claim, since once you are in litigation, you will likely be limited to that record which was before the insurer. If you personally purchased a policy, you have a Private Policy that is treated like any other insurance policy in the eyes of the law. These private policies of disability insurance do not require internal appeals, and you can pursue litigation or other dispute resolution mechanisms immediately. Even with a private policy, it is useful to prevent problems by bringing an experienced law team on board at the start. The partners at Frankel & Newfield work with many private policy owners to resolve disputed claims before commencing a lawsuit. However, when necessary, we aggressively pursue litigation on behalf of aggrieved policyholders throughout the country.
Secrets the Disability Insurance Companies Don't Want You to Know!