Short and long term disability insurance is supposed to offer policyholders peace of mind. Disability insurance provides a safety net in the event of an accidental injury or illness that prevents you from working. However, many insurers unreasonably deny benefits to which you are entitled. Prompt contact with a lawyer before final denial of a claim is vital to the claim’s ultimate success.
If you were denied short or long term disability insurance benefits, contact Scott, Kinney, Fjelstad & Mack, PLLC, in Seattle, Washington, to discuss your options and protect your rights.
There are two kinds of private disability policies: individual policies, which are purchased by the worker usually on their own, and group disability policies which are purchased by the employer and offered to workers as part of a benefit package. This second group generally means they are governed by ERISA. ERISA is the Employee Retirement Income Security Act of 1974. This is a complicated set of regulations and it governs how many disability policies are handled. It has specific rules regarding appeals, timing, etc… One caveat is that all public employees are exempt from ERISA. Even if they are group policies, they are handled under state law. It is important to speak with an attorney about what this means for your claim if it falls under ERISA.
We have recovered benefits for doctors, nurses, and other health care providers when professional disability insurance benefits were unjustly denied. We have also represented a wide variety of other individuals with disability insurance claims, including attorneys, law enforcement officers, public servants, teachers and stockbrokers. We have experience in state and federal court trials and appeals when either a private individual or group ERISA disability insurance claim is denied. We have successfully handled claims with Aetna, UNUM, CNA, Liberty Mutual, and The Standard, to name a few insurance companies.
One of the biggest mistakes disability clients often make is to handle their administrative appeals themselves. In the arena of ERISA claims, these administrative appeals are a crucial time to put your best case forward. Unfortunately, if you have exhausted your appeals and have to file your claim in court, you often cannot give additional testimony or evidence in support of your disability. If the file is closed without the proper information documenting your disability, your chances of prevailing are limited. Do not assume that the forms your doctor filled out that were requested by the insurance company will be adequate to document your disability. In addition, supportive employers do not mean that your claim will be allowed. Employers’ input has little to nothing to do with the claim process. Talk to an attorney when you receive your first denial or termination of benefits to maximize your chances of success.
The definition of disability varies from policy to policy. If you don’t have it already, request a copy from your employer. They may also give you something called a Summary Plan Description. While this can give the general terms of your disability policy, it is not the legal and binding document. Try to get copies of both.
One of the most important aspects of your insurance policy is the definition of disability. This varies but often fits into one of two general definitions. These are whether you must be disabled from your “own occupation” or “any occupation” to satisfy the policy and get paid benefits. Many policies have both definitions which are used at different times. Often, the definition of disability for the first 24 months of a claim is that to be found disabled you must be unable to do your own occupation. However, this often changes to “any occupation” after 24 months. Therefore, there are many people whose benefits are terminated after two years due to this definition change. Consult us if you want to review your policy or have questions regarding your claim.
In some cases, disabled persons are denied benefits and are discriminated against at work. If this situation applies to you, the attorneys at Scott, Kinney, Fjelstad & Mack, PLLC, can help. We will help you file a disability insurance claim against your insurance company and a discrimination claim against your employer. You deserve to be treated fairly, regardless of your physical condition.