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What You Need To Know Before You File for Disability

WRITTEN BY:
Justin Frankel
August 29, 2023 | Disability Insurance Claims
Over $250 Million Recovered for Our Clients

Navigating claims for long-term disability benefits can be daunting, filled with overwhelming paperwork, fraught with tight deadlines, and plagued by difficult negotiations with insurance carriers and adjusters. It’s a distressing and difficult journey that is further exacerbated if your claim is denied. Before filing, it is crucial to understand your disability insurance policy’s fine print, compile comprehensive medical records and employment documentation, and craft a persuasive narrative of your disability.

An experienced New York long-term disability attorney at the Law Office of Justin Frankel can help alleviate this burden, guiding you through the complex process, negotiating on your behalf, and attempting to secure your rightful disability insurance benefits. With professional legal advice, you can focus on recovery while maintaining financial stability. We have decades of experience assisting disability claimants nationwide.

Timelines and Expectations When Filing for Disability Insurance

Handicapped woman using an ID badge

 

When filing a claim, you may wonder what the normal timelines and expectations are or if there are any penalties for the insurance company when there is a delay. For New York and private policies, there is New York Insurance Law 2601, a statute that addresses unfair claim settlement practices.

New York Insurance Law 2601 states that no insurer that does business in New York can engage in practices that are considered unfair when settling claims. It further defines “unfair” as an insurer committing specific acts without good cause and doing so frequently enough to count as standard practice for the provider. These acts include:

  1. Deliberately and knowingly misrepresenting policy provisions and facts related to the relevant coverage
  2. Failing to provide reasonably prompt communications regarding policy claims
  3. Failing to maintain reasonable standards for claims investigations in a timely fashion
  4. Failing to act in good faith regarding fair and equitable claims settlements where liability is clear
  5. Failing to advise about a denial letter or acceptance of the insurance claim within 30 working days
  6. Offering substantially low settlements, thus forcing policyholders to initiate lawsuits to recover additional amounts
  7. Failure to properly disclose coverage related to the injury or claim
  8. Sending reasonable claims to independent dispute resolution
  9. Artificially reducing the value of adjusted claims, such as using inappropriate data for the region

The Employee Retirement Income Security Act (ERISA) sets standards for private retirement and health plans. ERISA has specific time frames for claims, but this is national and not limited to New York. For private claims in New York, the standard for disability insurance companies is one of reasonableness, and insurers must act in good faith and deal fairly with claimants and insured parties.

The New York statute and ERISA are both filled with legal terminology and may be confusing for the claimant to understand. This is why it is important to have representation from a long-term disability lawyer who is experienced in long-term disability insurance claims. Disability cases can get complex, and the New York-based law firm of the Law Office of Justin Frankel is ready to help you at every step, from your initial claim forms to collecting evidence, dealing with your independent medical examination, and engaging in the appeal process.

If your disability claim has been denied, call our attorneys for a free consultation. We serve claimants in all 50 states.

The Role of Your Physician in a Long-Term Disability Claim

With a short-term disability or long-term disability claim, your physician’s job is to help you demonstrate how your job has impacted your injury or created new symptoms that were not already present. This role is vital to getting your claim accepted. Your physician must take meticulous care when reporting, as the insurance company will use this report when determining the claim outcome.

If the doctor notes symptoms without tying them to the injury, if they fail to mention something that the two of you have discussed, or if they otherwise provide incomplete information, you may find your claim denied. Therefore, you must keep track of what and how your physician is reporting on your medical records. Your long-term disability lawyer can help you with this process.

Physician consultation with a patient

How to Respond Effectively to an Insurance Company’s Request for Information

When dealing with the insurance company, documentation is paramount for every interaction. Never accept a verbal agreement or statement as binding. Keep detailed records of every discussion between you and the insurance company, what was said, and what issues you and the insurer or adjuster agreed upon. Get everything in writing. It is best to conduct all communications about your disability plans and claims in writing rather than over the phone.

Do not ignore communications from your insurance provider. It is common for these companies to request further information or documentation of your disability or injury to solidify your claim. In some cases, they may question whether your injury meets the definition of disability under state disability law and will seek further clarification before approving benefit payments. Ignoring these requests can harm your chances of getting approved. Likewise, do not argue with or question their request.

If you have any questions or concerns about what the adjuster asks you to provide, you can speak with your disability attorney at the Law Office of Justin Frankel. We can take over communications for you to alleviate the stress and allow you to shift your focus to getting well again.

Understanding Possible Outcomes: Approval, Denial, and Appeals

When you file for disability insurance benefits, only a limited set of outcomes may occur. The best-case scenario is that your claim is approved, and you get your disability income. If the insurance company denies your disability benefits outright, it is best to seek legal advice from an experienced New York long-term disability attorney. You may still be able to file an administrative appeal or otherwise challenge the denial. It is important to understand that regardless of the initial outcome, there will be a waiting period of up to 30 days before you receive a decision.

Approved Disability Insurance

In a perfect world, all legitimate disability benefits claims would be approved without further trouble. An approved claim means everything moves forward as it should, and you will begin getting checks to cover your medical bills and lost income. Unfortunately, too many disability claims do not get approved for various reasons.

Denied Disability Insurance

Far too many disability insurance claims are denied upon first submission. Unfortunately, denials are common because insurance companies are for-profit entities and do not make money by paying large claims. Insurance companies have many reasons for denying these claims, from the injury not meeting the disability definition under state or federal law to insufficient medical evidence to support the claim.

Appealing the Decision

If you are one of the many people who the insurance company has denied access to disability benefits, it may not be the end of the road. However, appealing a disability denial can be a complex and time-consuming process.

Therefore, it is vital to have help from a qualified and experienced long-term disability attorney.

The appeals process can vary somewhat from provider to provider and state to state — for example, the process for a New York private or individual long-term disability appeal differs from that of an ERISA appeal. Your lawyer can outline the steps for you. You may need to provide a great deal of additional information before the process goes to court. Your attorney will be your guide every step of the way.

Not only can your disability lawyer help you build a strong case with medical records and evidence to back up your claim, but we can work with your doctor to help them complete their report in a way that supports your need for benefits. We can control communications with the insurer and policyholder if it is someone other than you, such as if you belong to a group long-term disability policy held by your employer. By handling communications, we can help avoid miscommunications and keep expectations clear. Above all, we can help you achieve peace of mind while you focus on recovering from your injury.

Why Hiring a Disability Lawyer Can Make a Difference

The best way to prepare for a disability insurance claim is to consult an attorney. At the Law Office of Justin Frankel, we handle our clients’ initial claim filing, gathering all necessary medical and occupational support. In each case, we work with the client, the treating physician, and, where appropriate, financial professionals to develop the evidence needed to assert your claim. We manage the entire claim process, including addressing the insurance company’s request for additional information, examinations, functional capacity evaluations (FCEs), field visits, and interviews. In this way, we can spot issues before they become claim problems. Engaging our legal team at the outset is valuable since we can anticipate and pre-empt concerns that could potentially harm your claim.

When preparing for the disability claims process, it is important to understand how complex the disability claims process is and recognize that it is loaded with potential problems. It helps to acknowledge that your claim will be scrutinized for any possible denial. Any information — from medical reports to telephone conversations — will become part of a file that the insurance company may use in administrative or legal proceedings to deny your claim. Starting with that premise may sound negative, but it is a helpful mindset to keep when filing a claim.

Disabled woman filing for disability

Prepare Your Long-Term Disability Claim With an Experienced Team

For individuals with complex medical conditions or those with multiple policies, preparing a claim with the help of an experienced lawyer from the start can make all the difference. We know that you and your loved ones are already overwhelmed. This is one less headache for you to deal with.

Start the Disability Claims Process With Confidence

If you have been injured and are no longer able to work, you do not have to walk the road alone. Having a disability lawyer in your corner from the moment you begin can help you get your claim approved the first time.

If you are denied disability insurance, your attorney can represent your interests to help you fight the denial and seek the disability income you need and deserve. Contact the disability insurance claim attorneys at the Law Office of Justin Frankel toll-free at 888-583-4959, and schedule your free consultation today. Our New York office services clients throughout the United States.

Justin C Frankel

Written By Justin Frankel

Attorney

Justin C. Frankel is committed to fighting for the rights of clients when their long term disability insurance claims have been denied, delayed or terminated.


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