Behind the Scenes:
Employer sponsored Short and Long-Term Disability plans are sold to people in one way but administered by insurers in quite another. Every day we hear from people frustrated because either their employer has paid for these benefits and promised them the benefits would be there if they couldn’t work, or even worse, frustrated because they have directly paid for these benefits and were told it would be there for them. Then, the rug is pulled out from under them by an insurer who merely sends a denial letter in the mail. Now you are left wondering how am I going to pay for food, housing, medical bills, and gas.
Every major insurer in this industry has a massive staff, all working directly on avoiding payment of your benefits. Insurers have doctors, nurses, vocational experts, therapists, lawyers, actuaries, and thousands of staffers all looking at files trying to find a means to denying your claim.
Insurers are also very adept at making you feel unconcerned about your claim until it is too late to stop an initial denial. They will tell you not to worry, just sign an authorization and they will get your medical records. What they don’t tell you is that their contracts and the relevant law puts the burden on your shoulders to ensure they get all of your records. If they don’t receive something, they will simply send the incomplete file to their own medical record reviewers for a paper file review. That individual, who is on the insurance company pay roll and who has never met or examined you, will then give an opinion as to whether you can or cannot work or do your job. If the insurer gets the opinion they want, your benefits are denied. If the insurer does not receive all of the paperwork its staff thinks is necessary, your benefits are denied. If your employer does not send all the paperwork the insurer thinks is necessary, your benefits are denied.
When insurers do this, you typically get one shot, that’s it, to fight this denial before having to go through litigation. This is why it is incredibly important that you speak with one of Kemmitt, Sanford and Kramer’s attorneys if your claim has been denied. Often, but not always, the rules governing Long-Term Disability claims in court limit the evidence that can be submitted to a judge. This means that the only way to ensure you are protected if your claim needs to go to court is to ensure every piece of favorable evidence or argument we can is a part of the appeal. This serves the dual purpose of increasing our chances at getting your benefits sooner through an appeal, and also, in protecting you if the insurer refuses to see reason and requires us to go to court.
Attorneys Mike Kemmitt, Evan Sanford and Patrick Kramer represent clients nationwide helping to fight these wrongly denied benefits. Whether you have questions about how to apply, what to do when they are dragging their feet, appealing a denial, or bringing a lawsuit we are here to help. Contact us today for a free consultation.