There are several steps to any insurance claim (be it long-term disability, short-term disability, or life insurance). Typically, the first step is making a claim. If you do this right, you can save a lot of headaches down the road.
If you are unsure about the claim process, or your claim has a high monetary value (which insurance companies routinely deny because remember – there’s no downside for them), you should consult with an attorney. We can look at your policy (each one is different), review your evidence, and let you know where you might need to add more detail or support to have your claim approved.
If your claim is denied at any point, you have the right to appeal the denial. Virtually every insurance policy has an appeal process. The insurance company will make it sound easy, and they may even give you a brief, helpful form to fill out. Don’t fall for that! Often you will just get one shot at this, so it’s important to get an attorney’s perspective. That’s why we will review your denial letter for free and give you a report of our findings and a plan for the appeal.
Depending on the insurance company and the policy language, you may have more than one appeal (this is true for all long-term disability, short-term disability, or life insurance policies). While a second appeal is usually optional, it can be an important opportunity to add evidence to your claim file.
Too often we are contacted by people who have filed multiple appeals and have exhausted their administrative appeal rights. It’s only then that they contact a lawyer, but unfortunately, by then it’s too late to add any new evidence. By the time we reach the lawsuit stage, a judge is only going to review what is in the insurance company's file already. No new evidence is allowed.
The insurance company knows this, and they are counting on the fact that you do not. So they get to add all the “independent” medical reviews, vocational analysis, etc. that they want. Do you think that the insurance company is going to fill the record with information favorable to you? We have never seen that happen!
Bottom line: know your rights and understand the insurance company tactics.