Many employers offer short term and long term disability insurance coverage as an employee benefit. The disability benefits are often insured by companies like CIGNA (Life Insurance Company of North America), Prudential, Unum, Liberty Mutual, Lincoln, MetLife, Mutual of Omaha, The Hartford, Sun Life, The Standard, Mass Mutual, Aetna, Assurant, Reliance Standard, or Anthem. Sometimes employee-sponsored disability benefits are administered by claims management companies such as Sedgwick CMS, Disability RMS, or Matrix Absence Management.
Group disability policies are typically governed by the Employee Retirement Income Security Act (ERISA), although certain group plans may be exempt from ERISA. Group disability plans issued to the employees of public schools, state or municipal employees, and church employees are usually exempt from ERISA. ERISA also does not apply to individual disability policies. Whether or not a policy is governed by ERISA is important because ERISA regulates the claimant's appeal rights and affects whether an individual can assert that the insurance company acted in 'bad faith' under Indiana law.
Indiana workers pay insurance premiums and depend on disability insurance benefits in the event of an injury or illness. Unfortunately, disability insurance companies or administrators may wrongfully deny a disabled individual's benefits. When a person receives a denial letter from an insurance company, they must appeal within a very limited period of time. If your short term or long term disability claim has been denied, immediately contact an Indianapolis disability lawyer at Keller & Keller for a free consultation.
Common Reasons for Disability Denial
The most common reasons a disability insurance company or administrator denies benefits include:
- Insurance companies or administrators will claim that the evidence does not prove the disabled individual meets the applicable definition of disability. Every disability policy includes a definition of 'Disability'. For long term disability (LTD) policies, it is common for this definition to include two distinct parts. Generally, the first part requires the claimant prove they are disabled from performing the duties of his or her 'own occupation' or 'regular occupation'. The second part changes the definition of disability after a set time period – such as 24 months – and requires the claimant prove they are disabled from performing the duties of 'any occupation.'
- The disability did not last for the entire 'elimination period'. The elimination period is a set amount of time (usually 90 to 180 days in LTD policies) that a claimant must prove to be disabled before they become eligible for disability benefits.
- The disability is caused by a mental health disorder and the policy limits the amount of time that benefits can be paid for mental health disorders.
- The claim is excluded by a pre-existing condition.
Appealing a Wrongful Denial
It can be devastating news when disability insurance benefits are denied. When short term or long term disability benefits are denied, the attorneys at Keller & Keller can provide a free consultation and determine if they can help you with your disability appeal.
“The appeal process is crucial to the success of a disability insurance claim. A skilled attorney at Keller & Keller can thoroughly review your case, prepare a strategy to contest the denial of benefits, gather all necessary evidence, and submit a persuasive appeal letter to the insurance company or administrator.”
After the appeal has been submitted, the insurance company or administrator will decide whether to approve disability benefits or maintain a denial.
After the appeal process is exhausted, the individual's only recourse is to file a lawsuit against the employee benefit plan and disability insurance company. If the insurance company continues to wrongly deny your benefits, Keller & Keller's attorneys will file a lawsuit and fight for your disability insurance benefits. The lawsuit will seek compensation of owed disability benefits and any other available remedies.
Free Short Term or Long Term Disability Consultation
The attorneys at Keller & Keller are dedicated to fighting for wrongfully denied short term and long term disability benefits. Keller & Keller has established itself as the most prominent law firm in Indiana to represent disabled individuals. We offer every Indiana resident a Zero Fee Guarantee, meaning you'll never pay for a consultation and the only way we are paid is if you receive disability benefits. To arrange a consultation, fill out our free contact form or call us at 1-800-253-5537 for a live consultation with one of our experienced Indianapolis disability attorneys.