K & K on delays, denials, and confusion
More often than not, insurance companies will look for ways to deny, delay, or discontinue payments of your long term disability benefits. When evidence of your illness is not unmistakably clear to your insurer - a challenge for those living with “invisible illnesses” - your insurer will likely deny your claim. It becomes easy for them to argue, “there is insufficient evidence of your illness,” or “your definition of disability does not meet our policy’s definition of disability.” Receiving responses like these can be infuriating, confusing, and worrisome.
So, what can be done to avoid these pitfalls and force insurers to pay you the benefits you are owed? Although you can hope for a swift and uncomplicated claim process… be prepared for the worst. Arm yourself with knowledge of common reasons for insurance denials and delays. Avoid unnecessary confusion by requesting a copy of your policy – and getting to know its language and terms. The more you understand about your policy and benefits, the easier it will be for you to demand that your insurer meet its obligations.
Insurers often attempt to delay or “toll” an insurance appeal, while they supposedly obtain additional information from third parties (such as an “independent” medical examination). We believe that ANY delay due to a request for third party information is an insufficient basis to “toll” the time for conducting an appeal and is an improper delay of the appeal process.
Don't let your insurance claims administrator take advantage of you, and delay the payment of your benefits longer than the law allows. Insist that they comply with the regulations and communicate with you in a timely manner. If you let them know that you are an educated consumer, the odds are that they will attend to your claim more carefully.
Know what to expect as a basis for denial of a claim, and do your best to provide as much evidence as possible to avoid these types of denials. Insurance companies are known to deny for reasons such as, “no objective findings,” “self-reported symptoms,” “activity level is inconsistent with claimed level of impairment,” and many others that might seem illogical or unfair. Be prepared for these types of denials, and use our tips below to be your own best advocate!
Insurers are counting on you to be confused! They are hoping you (1) don’t know what is available to you under your policy, (2) don’t understand your rights, and (3) that you will give up after a denial without an appeal. Don’t let your insurance company confuse and exhaust you! Dealing with a chronic illness can rob you of your time, energy, health, and therefore the ability to pursue a long term disability appeal. If you find that you do not feel well enough to handle your appeal on your own, do not hesitate to contact a reputable professional for help.
As attorneys who represent clients unfairly denied long term disability benefits, we are unfortunately all too familiar with the tactics used for improper decisions and wrongful denials by insurance companies. For those who do participate in long term disability coverage, it isn’t worth much if your insurer doesn’t pay you benefits when you need them. We know that the rules governing disability claims can sometimes be complicated, and insurance companies are not looking out for your best interests. If you or someone you know is having difficulty with a disability insurer, contact us.
We understand, and we can help.
www.kantorlaw.net (800) 446-7529
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