Philadelphia Disability Insurance Claim Denial Lawyers

Disability insurance exists to help those who are unable to return to work due to a disabling injury or illness replace a portion of their wages. This wage replacement can be crucial for individuals and families, but getting the benefits you’re entitled to under your policy can be challenging. Fortunately, with the help of an experienced attorney, you can get the knowledgeable legal assistance necessary to secure the full and fair benefits you need and deserve. If you need help with an application or if your application was unfairly denied, contact Abell and Capitan Law to speak with one of our Philadelphia disability insurance attorneys today.

We offer free case evaluations and will help you understand your insurance policy and what benefits you are eligible to claim, and will explain how the process works and how we can help you. Call us at (267) 419-7888 or reach out online to schedule your consultation. When you hire us, you won’t owe us anything until we secure benefits for you.

What Is Disability Insurance?

Most people don’t realize that disability and workers’ compensation are different types of benefits. Workers’ comp is coverage an employer provides for their employee’s job-related injury. Disability insurance is benefits provided to an individual for their non-job related injury that keeps them out of work for an extended period. There are three categories of disability an injured person can pursue. The disability benefits options available are the following:

  • Short-Term Disability: Provides wage replacement benefits for an injured person unable to work for less than a year.
  • Long-Term Disability: Provides wage replacement benefits for an injured person unable to work for more than a year.
  • Individual Disability: Benefits purchased by an individual who isn’t covered by their employer or is supplementing their current coverage.

An employer only provides workers’ compensation to their employees. When it comes to disability insurance, an injured person could seek benefits from multiple sources. The various plans you could file a claim for compensation from include:

  • Employer Paid: If you receive disability insurance from your employer, they typically pay the entire premium or just a portion of it, so you’re covered if you’re unable to work.
  • Employee Paid: If your employer doesn’t fund your disability insurance, but offers it as an option in your benefits package, you could opt for coverage by paying the premium yourself.
  • Member Coverage: If you’re a member of a professional association, disability insurance is available at a group rate.
  • Individual Plan: If you don’t get coverage through your employer or a professional association, you could apply through an insurance broker or directly from an insurance company.

Several states require employers to provide disability insurance to their employees. However, Pennsylvania does not require employers to provide this coverage. If your employer doesn’t offer disability benefits or if the coverage provided isn’t high enough, you could supplement with an individual plan. Many individuals prefer that option because you’re able to customize the compensation you could receive if you’re injured and out of work.

How Do I File A Claim for Long-Term Disability?

When you hire one of our Philadelphia disability insurance claim attorneys, we will start the claims process immediately. We know the critical deadlines and rules we must follow, so your claim gets approved. The first step to filing any claim is reviewing your insurance policy. We’ll determine if your plan allows for benefits related to your injury or illness.

When the initial application is submitted, insurance companies require forms and documentation regarding your situation to determine if you deserve assistance. We’ll help you with the process of filling out claimant forms, seeking medical examinations, collecting your medical records, and preparing for interviews.

Once your claim gets filed, the insurance company will review everything we provided and decide if you qualify for monthly payments. Depending on the extent of your injury and the amount of treatment required, you could receive monthly payments equivalent to your income. During the waiting period, it’s your job to continue treatment for your injury or illness. You should also maintain records of bank statements, and any other documentation to prove your injury or illness directly caused your absence from work. If the insurance company approves your claim, you could start to receive benefits immediately.

What Happens if My Claim Gets Denied?

You have the right to an appeal if the insurance company denies your claim for disability benefits. The Philadelphia disability insurance claim attorneys from Abell and Capitan Law are competent in appealing insurance company denials. We know how to review the denial letter and get to the root of the problem. We’ll gather evidence that could dispute the insurance company’s findings, so they reopen your claim.

Unfortunately, it is not uncommon for the insurance company to deny your claim. Many factors contribute to a denied disability insurance claim. The most common reasons include:

  • Lack of Medical Evidence: Undergoing treatment isn’t enough for your application to get approved. Your physician must state in your records that your injury or illness has directly affected your ability to perform at or return to work.
  • Upcoming Medical Procedure: Any future surgery could negatively impact your claim. Insurance companies will require proof that your surgery didn’t result in any complications requiring disability before moving forward with your original application.
  • Undiagnosed Condition: Symptoms with no known origin could result in unforeseen treatments in the future. If your physician is unsure of the cause of your condition, it could develop into something more severe. Your insurer won’t approve your claim until you submit additional documentation of your status, or you recover from it.
  • Ineligible Medical Condition: Disability insurance benefits don’t cover certain illnesses that claimants received a diagnosis for previously. If you sustained an injury as a direct result of your disease, you might also get denied any benefits.

What is ERISA, and How Does That Affect Me?

ERISA, Employee Retirement Income Security Act, is a federal law enacted to protect employee benefits. If your disability benefits come directly from your employer, it is subject to an ERISA claim, whether it’s a self-funded or insured plan. When it comes to a plan through the government or professional organization, it doesn’t fall under ERISA law.

Submitting all documents that support your ERISA claim early on is crucial. Adding additional documentation during the litigation process is more complicated. The most important documentation you must provide during the claims process include the following:

  • Copy of your disability insurance plan and summary of the coverage descriptions
  • Medical records from your providers demonstrating your disability
  • Job description from your employer showing the physical and/or mental requirements you’re unable to fulfill due to your injury or illness

There are special issues in long-term disability cases that prevent insurance companies from requiring objective evidence for a subjective problem. Insurance companies must consider mental health issues, pain, and the side effects of a medication when reviewing your claim. They are not allowed to deny your access to benefits based on subjective symptoms. You should remain mindful of any special issues you could include in your claim for long-term disability benefits. These special issues include the following:

  • Cognitive impairment
  • Pain and fatigue
  • Side effects of medication
  • Medicare eligibility
  • Mental illness
  • Worked while disabled

Contact a Philadelphia Disability Insurance Lawyer

If you or a loved one have become disabled and need assistance with your disability insurance claim in Philadelphia, contact Abell and Capitan Law to speak with a knowledgeable attorney right away. We’ve helped countless people across the country get the disability benefits they were entitled to under their employer’s policy or a private policy, so we’ll be ready to put our skills to work for you. Call us at (267) 419-7888 or fill out an online contact form to schedule your free, no-obligation case evaluation with us today.

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