Disability claims are often denied, but you don’t have to give up. There are steps you can take following a denial of benefits.
Many of us will, at some point in our lives, suffer an illness or injury that necessitates being out of work. We may need to recuperate from a sudden illness that left us too weak to function. We might require surgery and a lengthy rehabilitation period following a broken bone. We could be injured in an auto accident or on the job and need time to heal. Regardless of the reasons why, many employers and private insurers offer short-term disability insurance policies to provide income while we are away from our jobs recuperating.
In spite of having the foresight to have insurance for just such an occasion, oftentimes our claims are denied when we need this benefit the most. Just because your disability claim has been denied, doesn’t mean that you are out of luck, though. It may be possible to, depending on the type of policy you have, either file an appeal of a denied claim or to file a lawsuit to get the benefits you both need and deserve.
Claim denied by a private insurer
In most states, Illinois included, if your short-term or long-term disability claim has been denied by a private insurer (for a policy that you purchased yourself, not one provided by your employer), you will be able to file a legal claim for reconsideration immediately following the denial. This could lead to a swifter resolution for you because you don’t need to jump through any administrative hoops prior to seeking action. You might still need to provide additional medical documentation or cure any alleged defects in your claim application, but it does skip some of the “red tape” you might otherwise encounter.
If your claim has been denied not because of any shortcoming on your part – but instead because of the bad faith actions of your insurer or their breaching the policy contract – a legal claim might be the only way you’ll be able to get the benefits to which you are entitled and hold the insurance company accountable. In recent years, insurance giants like Cigna and Unum have been the subject of class actions regarding their unfair disability insurance practices, so you definitely are not alone if you have to bring a suit for this reason.
Claim denied under an employer-provided disability insurance policy
If the short- or long-term disability claim was made under an employer-provided insurance policy, you’ll need to follow claim appeal dictates set forth by the Employee Retirement Income Security Act (ERISA) before you can file a lawsuit. This means that, within 180 days of the initial claim denial, you’ll need to file an appeal and wait for reconsideration before you can file a private suit. Even under ERISA, though, you may be able to recover the income you lost while appealing the claim, as well as any attorney fees and court costs you incurred to get the benefits to which you were entitled.
Dealing with a disability, illness or injury is difficult, and you need to devote all your energy to getting better. It is during a time like this when you most need to lean on the resources at your disposal, including your short-term or long-term disability insurance. If your claim has been unfairly denied, you may have legal recourse. Contact the experienced insurance attorneys at DeBofsky Sherman Casciari Reynolds P.C. for more information; call them locally in the Chicago area at 312-561-4040.