All of the major insurance companies will tell you that you only need to fill out their application packets/paperwork to apply for benefits. However, the process is certainly more complex than simply checking and filling in some boxes.
At a minimum, you will need to have a physician that is willing to support in writing that you cannot or should not be working due to your health conditions or symptoms.
1. The first step is an application for benefits. You will fill out several pieces of paperwork and authorizations for the insurer. Your doctors will also be required to fill out forms regarding your conditions, treatment, and restrictions. The insurer will get all of this information, review it internally and issue a decision.
2. If the insurer denies your claim, in whole or in part, then you have the right to do a formal appeal. It is critical you reach out to Kemmitt, Sanford and Kramer Law to help with this appeal process as it is significantly more complex than the insurer would have you believe and could control whether you ever receive any long-term disability benefits. After submitting your appeal the insurer has 90 days (broken up between two 45 day windows) to issue a decision your claim. They will send our appeal and supporting documents to a new team for review and hire new doctors, nurses, vocational staff, and internal staffers to review. The insurer will then make a decision on whether to reverse their denial or maintain it.
3. Occasionally, some policies permit or require a second level appeal if the insurer maintains their denial following an initial appeal for benefits.
4. If the insurer has maintained its denial and no further appeals are available, then the next step is filing of a federal lawsuit to recoup your benefits. At this stage, depending upon where your long-term disability policy was issued and what law governs your claim litigation may look different. Often these claims are decided by a single judge on the written and oral arguments of the lawyers.
Everything in your application paperwork needs to be accurate, clear, and supportive of you satisfying the relevant disability policy’s eligibility requirements and definition of disability. Every policy is slightly different though many follow similar patterns and rules. Typically, long-term disability policies are divided into two time periods. During the first you have to provide evidence to the insurance company’s satisfaction establishing you are unable to perform your Own Occupation or Job. Thereafter, you will have to provide evidence to the insurance company’s satisfaction establishing that you are unable to perform any gainful work in the national economy.
Ideally, the process of a short or long-term disability claim is you apply for benefits and then receive your benefits. Regrettably, if you’re reading this you likely know long-term disability claims are not that simple. Kemmitt, Sanford and Kramer Law is focused at finding the most efficient and strongest resolution of your claim. The sooner you call Mike Kemmitt, Evan Sanford or Patrick Kramer, the sooner we can work on fighting for your benefits. Regardless of what stage your claim sits, contact Kemmitt, Sanford and Kramer today for a free consultation.