Wagar Law, P.A. is comprised of disability lawyers with experience in handling individual disability insurance claims, including applications for benefits, lump-sum buy-outs, appeals of denials of legitimate claims and litigation in both state and federal court. You should file a claim for disability income benefits when you are unable to work based on a mental and/or physical condition.
However, your policy may have limitations on a mental nervous condition claim, and as such, it is important that you understand all of the terms of your policy. Filing a claim for disability income benefits may appear to be a simple task. But, the application for benefits does not ask all of the questions to which the insurance carrier intends on obtaining answers. Thus, the carrier will delay paying or processing your claim under the guise that it needs additional information and documentation and will attempt to wear you down with the goal of having you abandon your claim.
Typically a group policy provided to you by your employer is governed by The Employee Retirement Income Security Act of 1974 (“ERISA”), a federal law that provides standards for how a claim is administered, including deadlines imposed on employees and insurance carriers for the filing, responding and appealing of a claim for benefits. While ERISA was enacted to protect workers, in practice it favors employers and carriers who know how to manipulate the facts, the claims process and the laws.
Carriers dedicate an enormous amount of time and resources to build a case for their denial of your claim for benefits which includes conducting surveillance and demand an independent medical evaluation (IME) or functional capacity evaluation (FCE),which they either may not have a right to conduct or if they do, they are may be conducting it in an manner inconsistent with their rights under the terms of the policy. For example, the carrier may schedule the evaluation to be conducted in another state or city, by someone other than a medical doctor or even an uninsured provider.
People purchase life insurance policies to protect their loved ones. Life insurance is essentially a contract between the policy owner and the insurance company (insurer) where the insurer agrees to pay a certain sum of money upon the death of the insured. However, life insurance companies often look for an excuse to deny a valid claim. With the exception of fraud committed by the insured, the most common reasons insurance companies deny a claim is that there was a misrepresentation, omission, or concealment by the insured at the time of application for the policy or a later amendment. Another common reason utilized by life insurance companies for denying claims is where a missed premium payment by the insured results in a lapse of coverage. These are only a few of the common strategies insurers employ to deny valid claims.