No one files an insurance claim because they are having a great day. You filed (or are planning to file) because something has gone wrong, and having your claim denied just kicks you while you’re down. We can help.
Benefit claims are denied all the time, most often for one of these two reasons:
- You do not meet the conditions defined in the policy. Insurance companies will argue that this is the ONLY reason claims are denied, but our vast experience tells us that’s not true. Very often…
- Your claim has been denied for a false or made-up reason, which is explained in official-sounding insurance language designed to make you give up and go away. This is a frivolous claim denial.
While there’s not much we can do in the first instance (except explain your policy in terms you can understand), in the second instance we can fight to overturn a frivolous, unprincipled, erroneous denial. Insurance companies don’t make it easy, though.
Why Do Insurance Companies (Actually) Deny Your Claim?
I’ve seen denials that are evil, and I’ve seen denials that are incompetent. Either way, the biggest problem is that the insurance company has no incentive to get their decision right and a big financial incentive to deny you. By denying your claim, they are saving money. If they get it wrong, there’s no penalty. Incredibly, all they will ever have to pay you is the money they should have paid you in the first place. That’s how the law is written. So they deny valid claims because:
- They are counting on you to simply walk away. Appealing a denial is hard, and they know many people with valid claims won’t even try.
- They are counting on you to appeal on your own. They know this is a complex area of the law and they are counting on you to make a mistake.
- It’s a numbers game. They know that if, for example, they deny 10 claims, maybe 4 people will find a lawyer to write an appeal they can’t deny and will get back on claim. They still come out ahead because most people WON’T do that.
Taking on the insurance company on your own is brave but is often a costly mistake. They have been in the business for a long time and have their own attorneys who spend all day, every day denying insurance claims. The insurance company will nearly always win when you appeal your claim on your own - they simply have the resources and experience to outmaneuver and overpower most claimants.
Here's how BenGlassLaw can help you right now:
- We will schedule a phone consultation with you so you can speak with one of our knowledgeable insurance appeals specialists.
- We will evaluate your claim and let you know whether you need to hire an attorney, or whether you can do this yourself (often you can submit an initial claim without an attorney).
- If you are planning to submit a claim for benefits, we can review your policy and your evidence and tell you where we think you need to better support your claim, and how to do that. That might be all the help you’ll ever need from us.
- If your claim has been denied, just fax/email/mail us the denial letter as soon as you get it. We will review it and give you a detailed strategy for moving forward. This service is free, but you must act promptly. The insurance company only gives you a limited time to appeal or their decision is permanent.
You can speak with our team of experts about your insurance claim by calling our office at (703) 584-7277.
When Should You Get Legal Advice Regarding Your Insurance Claim?
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.
What Type of Insurance Appeals Does BenGlassLaw Handle?
We do not handle health insurance claims, but if you are looking at any other kind of insurance claim or claim denial, call us. If we can’t help you ourselves, we’ll help you find someone who can. There are four main types of insurance benefits appeals that BenGlassLaw specializes in:
- Life Insurance
- ERISA Long-Term Disability
- ERISA Short-Term Disability
- Individual Disability Insurance
These insurance appeals cases are very different. Before you turn everything over to a lawyer – any lawyer - it is important to learn about the type of insurance you are making a claim for. Please use the links below to learn more! Remember – we are here if you have any questions or need more information.