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Practice Area
Disability Claims
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Individual Disability Claims Attorneys in New York

As experienced New York long-term disability claims lawyers, we know you need help throughout your battle with the disability insurance company. We know that the steady stream of letters requesting more information or asking you to come to a doctor’s office for an exam and other requests can be unsettling. We’re here with you every step of the way.

If you’re in need of a disability attorney, either in New York or nationwide, call the Law Office of Justin Frankel, PC at 888-583-4959.

How Does the Disability Claims Process Work?

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If you can’t work due to illness or injury, you should file a disability claim with your disability insurance company. Under your individual insurance policy, also known as a private insurance policy, you are entitled to coverage, provided your illness or injury fits your insurance company’s definition of disability. Most disability claims require you to provide information about your illness or injury, your job duties, and a doctor’s report that verifies your disability and your inability to work due to that disability. After submitting these documents, the insurance company reviews your case and decides whether to approve or deny your claim. It is in the insurance company’s best interest to deny your claim, so they will be looking for a reason to do so.

We hope you’ll contact us before you file a claim for long-term disability insurance benefits or even short-term benefits. The earlier we get involved, the smoother the process will be. That’s because your doctor’s reports and exam results all need to demonstrate not just that you are disabled but why you are unable to perform the tasks that your job requires. You may have a badly ruptured disc in your back and suffer from immense pain. Still, unless your medical records clearly indicate that you can’t perform your job duties, the disability insurance company may deny your claim.

The Law Office of Justin Frankel also works with your treating physician to help them understand how vital their medical records are to your case and what they can do to ensure the medical records properly document your limitations to support your claim.

Once you file a claim for disability insurance benefits, you may receive some correspondence from the disability insurance company advising you that your claim is being reviewed and asking for some additional information. They might even try to conduct a phone interview with you, which can be quite terrifying.

Don’t worry. We can help. 

The interview is where a claimant may unwittingly damage their claim. An experienced disability claim attorney can act as an intermediate with the insurance company to prevent any extraneous details from hurting your case.

The insurance company is only entitled to the information outlined in your disability insurance contract. For example, if you are a business owner, you may be asked to provide a decade of financial reports, even if your policy does not require that information to be shared. 

The disability insurance company may also ask for extensive medical records, some of which may seem unrelated to your claim. Your medical records from ten years ago may have nothing to do with your current condition. Still, unless you are in the disability insurance legal field, it’ll be difficult to read through your policy to find the exact language that defines what medical records you must share. You will likely feel intimidated by the insurance company. An attorney can ease this burden.

The disability insurance policy is a legally binding contract. It is at the heart of your claim — we often say it is the roadmap for the claim. But like many legal documents, it is complex and full of complicated language, usually written in the insurance company’s favor. That’s why an experienced disability insurance attorney can determine what you must provide to the insurance company when they ask for it and what you don’t have to provide while still satisfying your claimant obligations under the policy.

After the insurance company (or their third-party reviewing company) thoroughly reviews your paperwork, often utilizing biased medical reviewers, they decide to pay or deny your claim.

When your claim is denied or terminated, it’s time to call the legal team at the Law Office Of Justin Frankel.

Your Short-Term Disability Claim Matters

Think of your short-term disability insurance claim as the entrance ramp to disability insurance benefits. If your short-term disability claim is denied, you may never qualify for disability. In most cases, short-term disability claims are paid by your employer, but it’s the disability company that often administers the short-term claims. They are incentivized to keep you from completing the short-term claim process.

The disability insurance company benefits in several ways: they get advance notice on your claim and have the opportunity to review your claim, medical records, and work records. They can red flag your claim, especially if you are relatively young or have a high benefit amount.

Common Reasons for Individual Disability Insurance Claim Denials

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Insurance carriers have several common reasons they use to deny a disability case. These include lack of timely notification and documentation, insufficient documentation, a non-covered condition, dispute of the disability, dispute of the treatment, an error on the insurer’s part, and the existence of a pre-existing condition.

Lack of Timely Notification and Documentation

Even when you are injured or ill, the insurance company expects you to promptly submit all documentation of your disabling condition. Failure to submit documentation in a timely fashion can lead to denial of long-term disability benefits.

A New York state disability attorney can help you navigate the application process, meet deadlines, and properly complete your paperwork so that you can focus on your health. If you still get a denial letter, your short- or long-term disability lawyers can help you navigate the appeals process under disability law.

Insufficient Documentation

Disability plans require significant documentation of your disability. Before filing your initial claim, you must go to a doctor, receive all necessary medical tests and exams to confirm your medical condition, and submit all documentation and medical evidence clearly showing the extent of your disability and your inability to work.

Even then, short- and long-term disability claims are sometimes denied initially. It is vital to have the doctor involved in your care and medical treatment to be supportive of the claim. When the treating doctor is not fully supportive, it can be challenging for claims to succeed.

While it is clear that the fundamental reason for claims being denied is that paying claims cuts into profitability, there are substantive reasons why claimants don’t do enough to support their claims. Claimants often fail to ensure that their doctors have understood their functional deficits and limitations, and doctors often fail to properly articulate how and why a claimant suffers these deficits in functioning. Our work often involves helping to educate our clients and the doctors in these cases to bridge the medical and vocational issues.

Your Condition is Not Covered

Unfortunately, there is no standardized definition of “disability.” Disabilities can range from serious injuries to conditions like fibromyalgia, multiple sclerosis, and others. You should check your policy to see if your particular insurance plan covers your disability. Sometimes insurance companies will try to claim that your disability is not covered due to a pre-existing condition. An experienced New York disability law firm can review your contract, determine if the impairments you suffer qualify as a disability under your policy, and dispute any inappropriate denials.

Your Disability is Disputed

If your disability is based on self-reported symptoms and impairments like dizziness or chronic pain, the insurer may not believe you are receiving appropriate care or treatment in an effort to deny your claim.

Some policies may exclude claims based on self-reported symptoms. Review your contract to check if such exclusions apply to you. Your disability attorney can also help here.

The insurance company will likely conduct an investigation of your claim that will involve scrutinizing your daily routines, your behavior, and even your social media posts. They may use what they find to argue that you are not as disabled as you say you are.

You may also be required to undergo an Independent Medical Examination (IME). These exams are often highly biased in favor of the insurance company. The exam, for example, may not include all the necessary records of your disability. The examiner may also not have the proper training to evaluate your case. If you get a denial letter based on IME findings, your disability lawyer can help you dispute the denial.

Your Treatment is Disputed

The insurance company may disagree with your doctor’s assessment of your needed treatment. Your lawyer can help fight this.

Insurer Error

Sometimes, insurance providers make mistakes. That doesn’t mean you should be denied disability. Talk to a knowledgeable New York disability law office to pursue your case so you do not have to deal with bureaucracy while you heal.

You Have a Pre-Existing Condition

Pre-existing conditions are often used to deny policyholders the benefits they need for their disability. If your provider denies your claim for this reason, they should include the specific language from your contract in the letter denying your claim. A knowledgeable disability lawyer can help you review the cited clause they use to try to appeal the denial.

My Disability Insurance Claim Was Denied. How Do I Appeal?

Federal law outlines the appeals process for challenging a claim denial. These insurance laws, however, can be complex, and it can be easy to make a mistake. It is best to contact a qualified disability insurance attorney for help.

  • Get a copy of your insurance policy. Understanding the language of your policy and specifically the language used in your denial will be crucial.
  • Contact a disability lawyer as soon as possible. Involving a lawyer early in the process can help you meet deadlines, assemble necessary paperwork, understand the policy language used to deny your claim, and communicate with the insurance company.
  • Make a note of all relevant deadlines. Missing a deadline is the easiest way to lose your case.
  • Gather any missing information. Put together as much evidence as possible to support your disability claim and dispute the denial. This could involve missing or incomplete forms, additional medical documentation, or other evidence. Your attorney can help you with this step.

How ERISA Factors Into the Claim Process

If your disability insurance policy is paid for through payroll deductions and you received it as part of your employee benefits, then you need to know about ERISA, the Employee Retirement Income Security Act of 1974. ERISA was created to protect employee benefit plans, particularly pensions, from unscrupulous employers. However, disability insurance companies discovered they could use ERISA to take control of coverage disputes. ERISA creates problems for claimants who try to tackle denials independently because under ERISA:

  • Time limits to respond to the denial are short and inflexible.
  • There is no jury trial.
  • Appeals are decided by the same insurance company that denied or terminated the claim.
  • If the appeal is denied, the next step is a federal court case.
  • In federal court, a federal judge oversees a review of the claimant’s file.
  • Only materials in the claimant’s file may be considered by the judge.

Our Disability Insurance Lawyers Know How to Win Disability Cases

Man with a wrist injury - The Law Offices Of Justin Frankel

Every disability policy and fact pattern differs, but our experience and aggressive representation of our clients have led to many successful outcomes. We have overturned denials for clients at all stages of their claims and even won back benefits after terminations. While past performance does not guarantee future success, here are some examples of cases we have successfully represented.

  • A 42-year-old law professor was unable to teach, publish or work on committees because of several related conditions, including Lyme disease, Post-Lyme disease syndrome, POTS (Postural Orthostatic Tachycardia Syndrome), and the restrictions that her illnesses created. Her insurance company denied her claim. We fought back and got her a lump sum of past benefits and several months of continued payments. After several months, her insurance tried to terminate her claim again. Once again, we fought back, and she retained her disability benefits.
  • A 62-year-old man who had been the finance director for one of New York’s best nonprofit workforce development organizations underwent radiation treatment for lymphoma and experienced severe side effects. Afterward, he was diagnosed with a neurocognitive disorder and several co-morbid conditions that left him unable to work. His disability insurance company began an in-depth review of his claim, which we saw was actively seeking information to support a predetermined position of denial. Despite paying him benefits for two years and finding no change to his medical status, Guardian terminated his claim. We fought back with an aggressive ERISA appeal, and his benefits have now been reinstated.
  • After three years of receiving disability insurance benefits, a 55-year-old man’s claim was terminated. Nothing in the man’s condition had changed, and there was no warning that his insurance even considered terminating him. The Law Office of Justin Frankel fought for him with an ERISA appeal to reinstate his disability claim. We did so with a detailed vocational and medical analysis. We were able to have his termination reversed, and he continues to receive benefits.

How Can a New York Disability Lawyer Help Me?

We believe you and your family should focus on your health and adapting to your new circumstances. The last thing you need is the frustration, aggravation, and anxiety created by battling an insurance company. We work with our clients every step of the way so they don’t have to do it alone.

If you have any questions or want to learn more, please call us at 888-583-4959 for a free consultation or use our contact form for our team to reach out to you. Our New York law firm proudly serves claimants nationwide.

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