Disability claim denials can be appealed or resubmitted for reconsideration.
If you’ve been injured in an accident, diagnosed with an illness or had to deal with the prospect of a long recovery following surgery, you might need to be out of work to focus on your health. You could be worried more about the hit your finances will take during a work absence than your recovery. If you need time away from your job for a short-term or long-term disability, you may choose to file a claim with your disability insurer to make up some or all of the income you’ll lose.
Unfortunately, as is the case with many disability claims – those for disability insurance claims and Social Security – initial applications are often denied. This doesn’t mean that you don’t have a valid claim, nor does it mean that you should give up. Sometimes, simply resubmitting the claim with additional medical information will be enough to have it reconsidered and approved. Other times, further action will be needed. It is important to understand what type of policy you have, though, in order to understand what steps you need to take.
Private disability insurance policies
If you have your own short-term or long-term disability policy purchased from a private insurer, you might not have to go through any formal appeals process following a denial before you take legal action. Essentially, you could be able to file suit in a court of law immediately after an unfairly denied claim application. It doesn’t necessarily mean that you’ll prevail in a legal action, but you have the right to bring one. However, it might turn out that you would be better served to resubmit the claim with additional information. You could also ask if more test results or a letter from your physician would be sufficient to have your claim reconsidered. What steps you take will need to be determined by the policy itself and the terms set forth in the plan documents.
ERISA/employer-provided disability policies
If you have a disability claim denied under an employer-provided disability policy, you’ll need to follow the appeal and reconsideration provisions set forth in federal law. This means, among other things, that you must meet appeal deadlines (meaning that you must file an appeal within 180 days of your claim being denied) and follow proper administrative procedures before you can bring a suit to challenge a denied claim. Because ERISA law can be complicated, and the exacting criteria you need to meet can be confusing, it is probably best to proceed with the guidance of an experienced disability benefits attorney like those at DeBofsky Sherman Casciari Reynolds P.C. Call the firm today at 312-561-4040 or send an email to get started.