James T. Nyeste Attorney at Law CoverageLaw.com
Disability insurance exists for the sole purpose of protecting employees who suddenly found themselves unable to work due to a physical or mental condition. Employees typically pay into these programs with deductions from every paycheck, and many don’t give this a second thought until the unthinkable happens. Unfortunately, coverage is often denied even if there is a legitimate disability. Likewise, benefits may be granted and then wrongly terminated even though you continue to be disabled.
If you have followed all of the proper steps to apply for benefits and you feel that your disability claim was denied or benefits terminated for non-legitimate reasons, the first step is to make an internal appeal with the insurance company. Generally, it is necessary to pursue this appeal before you can file a lawsuit. Insurance companies are required to reexamine claims that were initially denied, and if they refuse to do so it is considered a breach of contract.
If your appeal for benefits is unsuccessful, there may be an optional appeal available to a higher level in the insurance company or to an independent third party, but in most cases your next step will be to file a lawsuit.
Of the many reasons insurers cite when rejecting claims, the most common include: Employee is not disabled enough to receive benefits or the condition is not severe enough to prevent the employee from performing his or her job duties; employee's doctor states there is no disability; or employee's condition is not covered as a disability.
When benefits have been granted and later terminated, it is often due to the change in definition of “disability” that takes effect after benefits have been paid for, typically, two years. For the first two years of benefits, you are disabled if you cannot perform the duties of your own job. After two years of benefits, you are disabled only if you cannot perform the duties of “any” job. But this definitional change is not as onerous as it may appear, and many termination decisions by insurance companies are not legitimate.
If your rejection or termination letter states any of these reasons, it does not mean that you are not entitled to the benefits of your claim. This means that in the opinion of the insurance company it is not required to pay out your coverage. But that is just the insurance company’s opinion, which often is unjustified.
If your benefits have been denied or terminated, it is time to consider hiring an attorney. An experienced Chicago insurance lawyer can help you successfully appeal your case. Attorneys understand the laws regarding disability claims and give expert advice to guide you in the right direction towards a successful appeal. Insurance companies are aware of this; they may be less willing to issue further denials and more willing to pay benefits or issue settlement checks instead.
Hiring a Chicago insurance lawyer to guide you through the appeals process can be invaluable. This shows the insurance company that they cannot simply deny your claim for insurance that you have been paying into your entire working life. Employees, who are legitimately disabled, whether it's short term or long term, have every right to collect disability payments.
You don't have to settle for denials that were made in bad faith regarding your coverage. By hiring a Chicago insurance lawyer, your chances of successfully winning your appeal are much greater and this is the first step on the road to recovery from any disability.