There are three potential steps, or levels, in the long term disability payment approval process:
1. Applications Process – an application is submitted and the insurance company approves or denies it.
2. Appeal Process – if your application is denied, you have a limited time in which to submit an appeal. The insurance company can then take several months before it decides whether to approve or deny the claim.
3. Lawsuit – if your appeal is denied, you can file a lawsuit. This is generally the first opportunity you have to file a lawsuit because you can’t do it until you have submitted an appeal and been denied.
Each of these layers builds on top of the one before it. In other words, the information submitted in the applications process goes into the claims file and stays there throughout the life of the claim. This means that, if something harmful is submitted, it stays in the file and will potentially harm the claim later.
There are a few things that might surprise you about this process:
1. The insurance company is not your friend, regardless of how nice the adjuster is to you.
2. The insurance company has the right to obtain copies of your medical records and communicate directly with your doctors, without you being present.
3. The insurance company has the right to have you examined by a doctor that it chooses.
4. The insurance company may have someone follow you and videotape you, without your permission and without your knowledge.
5. The insurance company can decide that you are not disabled, even if your doctors say you are disabled and you cannot work.
6. Long term disability insurance claims have strict time limits and deadlines. If you miss one, your claim may be denied, based only on missing the deadline.
7. Each contact you have with the insurance company will be noted in the claims file and may be used against you.
The process of getting long term disability insurance benefits approved is complex. If anything is done incorrectly, it increases the chances that your claim will be denied. If your claim is denied, it will take a long, long time to get it approved, if that is even possible.
Unfortunately, many people who are disabled attempt to handle the application process and appeal on their own. As a result, their claims are often denied. To make matters worse, the mistakes they made which caused their claims to be denied often cannot be undone and make it much more difficult for an attorney to fix the situation and get their claim approved.
If you are disabled and have a long term disability insurance policy, it is very important that you contact an attorney as soon as possible (even before filing an application). It is equally important that you hire an attorney who is experienced in long term disability insurance claims and who understands the complexities.
At Nelson Boyd, we have been handling long term disability insurance claims for years and understand how to handle them. If you need to file for long term disability insurance benefits, give us a call at (206) 971-7601.