It is common for insurance companies who have sold you a disability policy to attempt to cancel benefits, claiming that the disability is no longer present or severe enough to prevent employment. This most commonly occurs between two and four years after receiving benefits, depending on the type of language on your contract. Most disability insurance policies include a two to four year period after which the definition of total disability changes. The definition tends to get narrower, which is generally bad for the policyholder. This change can take the form of either an increase in the number of occupations that should be considered before determining if you have a disability, or a reduction in the requirements to meet a persistent disability.
In addition, disability policies include the insurance company’s right to collect your medical records and have you periodically examined to determine if you are still disabled.
If you and your physicians know that you are still disabled, you must act quickly and thoroughly when an insurance company informs you of its intention to limit or discontinue your benefits under the disability policy.
As a rule, the insurer will notify you in writing and tell you the reasons for the loss or suspension of your benefits. This letter also contains important information on how to appeal the insurance company’s decision. First, the letter should give you the necessary instructions on how to appeal the decision. Most disability plans have provisions that require an appeals process before a claim can be filed. Whether or not these particular objections need to be followed is a legal issue that can only be determined once it is known which laws apply to your particular insurance contract. However, it is generally advisable to pursue the appeals process as it is your first opportunity to reverse the decision. The letters should also inform you of the insurance terms, conditions, or exclusions that the insurance company identifies as part of the agreement that entitles them to cancel or abolish your benefits.
In particular, insurance companies do not always interpret these provisions correctly and therefore need to be closely examined to determine whether the insurance company is relying on the correct language, omitting the relevant language or misinterpreting the language. Finally, the letter will also detail the specific reasons the insurance company claims that you do not meet the criteria for disability. This information represents the facts on which the insurance company bases its decision and should be a primary focus of your attack.
If you have received such a notice or notice of termination from your insurance company, it is advisable to consult knowledgeable attorneys for insurance claim disputes. However, if you wish to proceed alone, you should familiarize yourself with all three elements of the above letter and do adequate research to understand the language of the contract, the applicable law, the time, method and procedure for appeals, and the disputed factual issues.
To challenge the insurance company’s decision, you should immediately obtain medical evidence to support your claim that you are disabled. This information comes from your medical records and even better treat you doctors. You should contact each of your treating physicians and provide them with a copy of the cancellation letter from the insurance company. If your doctors still believe you are disabled, ask your doctors to write letters detailing the medical reasons that lead them to conclude that you are disabled. The doctor should also state their opinion that you remain disabled in their letter.
You should also write to the company and ask them to provide you with a copy of your claims file and any documentary evidence supporting the facts on which they based their decision.
In doing so, you should be aware that insurance companies are subject to laws that have been passed in each of the 50 states of the United States regarding fair claims settlement. Most state departments of insurance have specific regulations in place to implement these fair practice entitlement laws. For example, most states have specific requirements for the timeframe within which an insurance company should respond and the specific types of information they must provide you. In addition, common law has developed legal rules that apply to insurance companies.
You should prepare your appeal properly and provide the insurer with all the required documentation before the specified deadlines.
Your letter should include a statement that you disagree with the insurance company’s decision and your reasons for appealing. This is based on the medical records and evidence you have received from your doctors, as well as the relevant contract language and applicable law.
You can also contact your state Department of Insurance and file a complaint. If you do so, you can attach a copy of the complaint to your appeal.
Appealing a denial of service requires knowledge, skill and determination. If you are unable to meet this challenge yourself, you should consult an experienced insurance litigation attorney to assist you with your appeal and, if the appeal is denied, file a proper complaint on your behalf to obtain the benefits of the claim insurance policy that you have purchased and paid for.