When a person is unable to work due to a disabling injury or medical condition, obtaining benefits under an individual disability income insurance (IDI) policy or a group long-term disability (LTD) insurance policy is of a major concern for financial stability. The claims process is often foreign for disabled claimants. Filling out the forms and continuing to receive medical tests and treatment often seem like the only steps a person needs to take to obtain LTD benefits for a valid claim.
Qualifying for disability benefits often requires claimants to face many hurdles. An initial claim denial is not the end of the road, though. If you have group coverage, it is likely governed by ERISA, the Employee Retirement Income Security Act. One of the benefits of ERISA is that if a claim is denied, the claimant is statutorily entitled to a full and fair review of the denial. Taking advantage of that right and appealing the benefit denial is not only of critical importance in ultimately achieving success; it is a necessary precursor to filing a lawsuit to challenge the denial of benefits. And if done right, the claim will often be approved without the need for litigation. But even if the appeal is not immediately successful, it will set the stage for a successful benefit recovery in court.
Given the high cost of nursing home care, assisted living, or home health care, many people have purchased long-term care insurance with the expectation that it will cover the costs of their care should they ever need such services. Unfortunately, those expectations have not always been met because insurance companies have challenged claims and shown reluctance to pay benefits under long-term care policies.
Awareness of Post Traumatic Stress Disorder has increased in recent years, especially in light of news reports about veterans and warriors suffering from the condition after serving our country. What many people are not aware of is the fact the PTSD is not solely linked to military service. Any terrifying or traumatic event can serve as the basis for PTSD – ranging from being in a car accident to witnessing the death of a loved one.
Insurance companies often hire private investigators to find ways to deny or discontinue payment of disability insurance benefits. The tactics that big business uses to develop evidence seems to expand as technology changes. For years, insurance companies have sent investigators to conduct undercover surveillance stake outs, hoping to secure video evidence that a claimant is not really disabled, or is less injured than he or she claims. However, in a court ruling obtained several years ago by our firm, Skibbe v. Metro. Life Ins. Co., No. 05 C 3658, 2007 WL 2874035, at *11 n. 3 (N.D. Ill. Sept. 24, 2007), the court pointed out: