Long-Term Disability Insurance Claims & Appeals Lawyer in Kentucky
Kentucky's Will Driscoll Can Help
You look at your paycheck deductions, see a debit for long-term disability insurance and figure you are covered if you become disabled, right? Then you file a claim and it is denied. What have you been paying for?
It turns out that insurance companies are denying long-term disability claims on an alarmingly regular basis. It is important to hire an experienced attorney immediately to file your internal appeal. William J. Driscoll is experienced in long-term disability insurance claims and appeals.
Your Claim May Be Governed by ERISA
The federal government enacted legislation called "ERISA" in 1974 to set minimum standards for employer-sponsored benefit plans, with the intent to protect employee's benefits. However, while ERISA did secure employee's rights to their pensions, it actually gave employers, and their insurers, immunity from bad faith claims relating to their administration of other benefits, such as disability insurance claims. As a result, employers and their insurers have little down side to playing hardball on short term or long-term disability claims, as the most they can be sued for are the past-due benefits. There are no damages for bad faith, mental anguish, or punitive damages, and attorney fees are rarely awarded.
Further, the claimant must prove that the employer or insurer's decision is "arbitrary and capricious", which is the highest burden of proof in a civil case. So long as the employer or insurance company had a rational basis for the benefit decision, the federal court will not reverse that decision. Worse yet, the opinion of the treating physician is not binding on the employer or insurer, nor is the fact that the Social Security Administration has found the claimant to be fully disabled.
Under ERISA disability law, there are internal appeals processes that must be followed. Once the internal appeals process is exhausted, it is usually too late to submit additional proof. The federal judge will perform what is called a "judicial review of the administrative file", meaning that there are no hearings, no depositions and no trial. The evidence is limited to what is in your claim's file.
It is important to know that if you miss your 180-day deadline to appeal, there is nothing you can do. If you file suit, the federal court will rule that you "failed to pursue your administrative remedies."
It is also important to note that some disability policies have short deadlines in which to file suit after your appeal is denied. Often, this policy deadline is two or three years, but some are 12 months or shorter. In my experience, the federal court will enforce these deadlines, even though the claimant has been seriously ill during that time.
Individual disability insurance policies are not subject to ERISA law, but your claim can still be denied.
Will Driscoll has represented clients in claims and appeals against major long-term disability insurance companies, including
- UNUM Provident
- MetLife
- CIGNA/LINA
- Anthem Life
- Aetna
- Lincoln Financial
- Prudential
- MassMutual
- The Hartford
In Kentucky, call Driscoll & Associates at 888-558-5910 or contact us online.
Highest Burden of Proof Means You Need an Experienced Lawyer
A disability claimant must prove that the benefits decision was "arbitrary and capricious", which is the highest burden of proof in a civil case, similar to the criminal standard of proof of "beyond a reasonable doubt." Trying to do the internal appeals process yourself could be a big mistake. A good attorney will know what the insurance company is looking for, and what additional proof needs to be submitted to maximize your chances of winning you appeal or, if necessary, your lawsuit.
Falling Into the Gap
Your company doctor says you are disabled and cannot work. HR tells you to apply for long-term disability benefits. Then the insurance company says you are not disabled. This can drag for months or years. In the meantime, you are not getting a paycheck, or a disability check. Get help for your disability claim from Driscoll & Associates. We push our cases aggressively, so you can start getting a paycheck again. In Kentucky call 888-558-5910 or contact us online.
Waiver of Premium
This is an insurance benefit that your life insurance policy may offer. It is an option that allows you, the policyholder, to not pay your life insurance premiums when you become disabled. But what they don't tell you is that if your LTD insurance company denies your claim, your life insurance company will follow their lead.
It seems insurance companies are looking for any reason to deny you benefits. If you are pursuing a claim for Long-Term Disability benefits, continue your health insurance through COBRA, if possible, to avoid a lapse of coverage (and resulting pre-existing exclusion later), and put a lawyer with experience on your side.
With an office in Louisville, Will Driscoll handles cases throughout Kentucky. By associating with local counsel, we can represent clients anywhere in the USA. In Kentucky, call Driscoll & Associates at 888-558-5910 or contact us online.
