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Miami Disability Insurance Lawyers Tips: Successfully Appealing Long-Term Disability Insurance Benefits

Fri Oct 15th, 2021 on     Long-Term Disability,    

Many people have money taken out of their checks every pay period for long-term disability insurance benefits. It is a way of ensuring that those you love will be taken care of should you become injured and unable to provide for them. It is insurance that you will be able to pay your mortgage even if you become too sick to work. Unfortunately, these best-laid plans are often thwarted when the insurance company denies your claim for long-term disability insurance benefits. When this happens, you must appeal, and how that appeal is handled will determine if it is upheld or overturned. Miami disability insurance lawyers can help with every step of the appeal process to maximize your potential to succeed. Below are some tips on how to be successful. 

Request a Copy of Your Policy

If you have not already done so, request a copy of your long-term disability insurance policy from either the Human Resource Department at your employer or directly from the insurance company plan administrator. Send your request in writing. Once you have received the copy of the policy, review it in detail. 

Review Denial Letter

When your initial claim is denied, the insurance company is required to provide you with a denial letter. A denial letter will contain important information, such as:

  • The reason why your claim was denied
  • What additional documentation is needed for your claim to be successful
  • How to file an appeal of your claim denial

Request & Review a Copy of Your Claim File

Immediately after receiving your denial letter, request a copy of your claim file. Under the law, the insurance company is required to provide this to you, free of charge. It is important to obtain this file so you will know exactly what the insurance company had in their possession when they denied your claim. 

Do Not Miss A Deadline

No matter how worthy your claim or how much additional information you have to support your claim on appeal, it will likely not matter if you miss the deadline for filing your appeal. Insurance companies are required to give you 60 days, but most provide more time than that. 

Document, Document, Document

Having the denial letter helps you understand what additional information the insurance company is requesting in order for you to win your case on appeal. Once you have this information, you need to collect all documentation that can assist in your appeal. This may include:

  • Medical Records: Did you provide all of your medical records when you filed your claim? If so, were the copies you provided complete? If you did not provide all your medical records or gave them incomplete copies, you will need to remedy this on appeal.
  • Doctor’s Note: Obtain a written statement from your physician that supports your claim.
  • Vocational Expert Note: Have a vocational expert write a statement regarding how your disability has prevented you from being able to work as you did before. 
  • Letters: Ask your friends, family, and former co-workers to write a statement regarding the impact the injury has had on your life and the limitations you now have.
  • Additional Testing: Is there any additional testing you can have performed that will aid in your appeal? If so, have those tests completed.

Request Proof of Receipt

All communication between you and the insurance company should be in writing. If there is oral communication, as soon as you are able, write down a summary of that conversation and send it to the insurance company with a statement that indicates this is what you understood that conversation to mean. Include the date and the name of the party with whom you spoke. Most importantly, all communication sent to the insurance company must be mailed with a request for proof of receipt. This is to prevent the insurance company from later maintaining that they did not receive correspondence that you sent to them, which is a tactic our Miami disability insurance lawyers have encountered before.

Be Aware of Surveillance

Insurance fraud costs insurers a significant amount of money each year. Because of that, insurers do have surveillance measures in place to ensure that policyholders are not faking an injury or sickness to obtain disability insurance benefits. Even if your claim is valid, you still need to be aware that the insurance company is watching because they may attempt to use anything you say or do to bolster their argument that you are not actually disabled. They are not allowed to conduct any outside surveillance to see inside of your home. If you allow them into your home, however, they are permitted to document anything they observe. Forms of surveillance they may use include:

    • Tracking: Tracking may be done by an investigator to determine where you go. This can be accomplished by physically following you or by using a GPS.
    • Internet: Internet surveillance may be used to determine your activity. This includes checking your social media for status updates and pictures they may later use as proof that you are not entitled to disability insurance benefits.
    • Stakeouts: A stakeout is just that — an investigator may stakeout your home or work to observe your activity.
    • Technical: Technical surveillance tactics, such as placing recording devices and cameras in areas that you frequent, are used in an attempt to capture evidence that you are not actually disabled. 

Retain Our Experienced Miami Disability Insurance Lawyers To Fight For You

Even if you follow all of the tips listed above, there are still matters you may need to address with an attorney. The laws applicable to your case depend partly on whether or not your claim is governed by the Employee Retirement Insurance Security Act (ERISA). Knowledgeable Miami disability insurance lawyers can make this determination for you and assist you with the appeals process. Our firm has a successful track record of helping policyholders in complex appeals for disability insurance benefits, and we invite you to contact us to schedule a consultation.

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