Disability Insurance Claims Review & Appeals

Being unable to work due to a disability is a life-changing experience. The financial and emotional tolls can be incredibly challenging to overcome. As if the disability itself weren’t enough of a burden, dealing with the disability claims process can often feel like a never-ending uphill battle. At Monahan Tucker Law, we understand this process can be overwhelming and want to provide some guidance for those seeking to navigate the disability claims process. Below is the typical process for filing a long-term disability claim.

Last Day Worked

The first step in filing a disability claim is determining your last day of work. This is the day that you stopped working due to the disability, and it will determine the start date of your disability coverage. It is important to keep track of this information as accurately as possible. Missing out on coverage for even a day can be a costly mistake.

Notify Insurer and Submit Your Claim

Once you have determined your last day of work, the next step is to notify your insurer and submit a claim. You will need to provide medical documentation of your disability, which will be used to determine if you qualify for benefits. The claims process can take some time, so it is important to be patient.

Insurer Denies Claim

If your claim is denied, don’t lose hope. This is a common occurrence in the disability claims process. Insurers are often hesitant to approve claims and may deny them without adequate investigation. If this happens to you, the next step is to submit an administrative appeal.

Submit Your Appeal

The insurance company’s appeal process is your chance to provide additional information about your disability that may have been missed during the initial claims process. You can include new medical documentation, provide additional information about how your disability affects your ability to work, and generally make a case for why you should receive benefits. It is important to provide as much information as possible about your condition and how it affects you.

Decision Rendered on Appeal – Benefits Approved Most of the Time

While there is no guarantee that your appeal will be approved, it is often more successful than the initial claim. Insurers are more likely to take the appeal seriously, and the additional information provided can often sway the decision in your favor. If your administrative appeal is successful, congratulations! You will receive the benefits you need. If your claim is still not approved, you may need to file a lawsuit to pursue benefits.

Complaint Filed

If you’ve exhausted the insurance company’s internal appeal process and your claim was still denied, you may be eligible to file a lawsuit against the insurer. This requires filing a “complaint” with the appropriate court. Individual disability policies are often governed by state law, but policies subject to ERISA are governed by federal courts. An attorney from Monahan Tucker Law can help you determine if a lawsuit is in your best interest and explain which court will have jurisdiction over your case.

Settlement or Judgment

Both sides in the lawsuit will be given an opportunity to gather evidence and prepare for a hearing. The amount of time this takes can vary greatly depending on the nature of the case and the court that is overseeing it. Negotiations may continue during this time and can result in a settlement. If no settlement is reached, the case will go before the court for a final decision.

Peace of Mind

Receiving long-term disability benefits can be an important lifeline for people who can no longer work. At Monahan Tucker Law, we know that families count on those benefits, and we work hard to get them approved. When you work with our firm, you will have the satisfaction of knowing that you presented the strongest case possible in the fight for your benefits.

Help Completing the Disability Claims Process

Navigating the disability claims process can be challenging, but it is important to remember that you are not alone. At Monahan Tucker Law, we are here to provide guidance and support throughout the process. Contact us today, and our team will take care of you every step of the way.