Chicago Long Term Disability Claim Lawyer Assisting With Appeals and Contentions
If you’re a long-term disability insurance insured who is suffering from a serious injury, illness, or other condition that is impacting on your ability to perform the duties of your occupation, you may be entitled to benefits under the terms of your plan.
Unfortunately, insurance carriers often deny and mishandle disability benefits claims — even those that might be legitimate — for a number of reasons that are not necessarily clear to the policyholder without professional assistance. Sometimes, an insurer may deny a claim because the application for benefits is simply lacking adequate documentary evidence in support of the claim. Other times, an insurer may deny a “close” case claim and apply an exclusion too broadly, thus wrongfully denying benefits.
Because insurers tend to be rather “trigger-happy” when it comes to denying or otherwise mishandling disability benefits claims, it’s important that you refuse to accept the adverse decision of your insurance carrier. If you have a legitimate benefits claim, then you should challenge the denial.
Private disability insurance plans — whether short-term or long-term — can vary quite significantly. Given the likelihood of confusion (with regard to your rights and entitlements under your disability insurance plan), and the variety inherent to such policies, it’s worth consulting with an experienced Chicago long term disability claim lawyer for assistance in evaluating your insurance contract.
Here at Bryant Legal Group, P.C., our attorneys have extensive experience with helping policyholders submit benefits claims and challenge wrongful denials, through internal appeals processes and in civil litigation. Contact our firm today for further information.
Challenging the Denial of a Long Term Disability Claim
If your claim has been denied by your insurer, then you have the right to appeal the decision of the insurer, whether through an internal appeals process (or through a lawsuit against the insurer for damages). Internal appeals processes are not necessarily pointless. In fact, with the aid of a skilled attorney, going through the internal appeals process can lead to a less-costly and more efficient procedure for obtaining your rightful benefits. Of course, in the private disability insurance context, there are substantial differences in how the internal appeals process is structured (from plan-to-plan).
If you have gone through the internal appeals process and received an affirmation of the insurer’s original denial decision, then you may have to proceed with litigation against the insurer to secure the benefits that you’re owed. It’s worth noting, however, that it is not necessarily a pre-requisite to a lawsuit to go through the internal appeals process (except for ERISA-governed plans), so make sure to consult with your attorney for guidance on what steps to take with your dispute.
There is a huge range of possibilities for what the insurer might have used to justify their denial of your disability benefits claim. Your insurer might argue that there was simply insufficient evidence in support of your claim, or might argue that one of the policy exclusions applied to your claim.
It’s important not to allow these justifications to persuade you into complacency — countering these arguments is possible, depending on the particular circumstances of your case. In Illinois, for example, ambiguous exclusion clauses must be interpreted in favor of the policyholder, which can give you a substantial advantage when challenging the denial of your otherwise legitimate disability benefits claim.
ERISA Plans Require Exhaustion of Administrative Remedies
If you are a policyholder in an ERISA-governed disability insurance plan (i.e., a qualified employer-sponsored disability plan), then your claim — and any subsequent dispute — will be subject to federal ERISA regulation.
Under ERISA, if your claim is denied, then a letter of denial will be sent to you, after which the administrative appeals process will be set in motion.
ERISA prohibits civil actions against insurers and plan administrators before the policyholder has exhausted all their administrative remedies under the plan at-issue. Generally speaking, this entails going through the internal, administrative appeals process, which can be rather complicated. If the administrative appeals process does not lead to a reversal of the insurer’s decision to deny benefits, then you are entitled to bring a civil action against the insurer and recover the benefits you are entitled to.
Speak to a Skilled Chicago Long Term Disability Claim Lawyer for Comprehensive Assistance
Bryant Legal Group, P.C. is a boutique insurance litigation firm with attorneys who have decades of experience representing the interests of policyholders, including those involved in disputes against disability insurance carriers. We are aggressive advocates for our clients, and have a long and consistent record of success in litigating claims against insurers and helping our policyholder-clients obtain the disability benefits they rightly deserve (in addition to various other damages, depending on the circumstances of the dispute).
Our team believes that effective legal representation — particularly in the insurance dispute context — demands a client-focused and comprehensive approach. As such, we work closely with clients and staff medical experts to evaluate the contours of the disability at-issue and develop a solid foundation for obtaining benefits.