Like many of our clients, you may have purchased a private long term disability (LTD) insurance plan through an independent broker.
Another common type of long term disability is group disability. These policies are often provided as part of a benefit package through your employer.
What sets private policies apart from group policies are:
- The procedures involved in filing claims; and
- The process of appealing private disability claim denials.
The laws that govern and control these insurance policies (and your rights) are quite different. In either case, you expect your insurance company to honor their obligations as stated in the policy.
Unfortunately, insurance companies do not always play fair.
Many LTD insurance carriers are known for wrongly denying valid claims, delaying payments, or terminating existing insurance payments. They issue intentionally confusing policies and find excuses to deny large claims. Their bag of tricks is resourceful. Their goal is to contain costs and increase profits.
You purchase private disability insurance as a safety net. This policy should ensure a vital source of income in the event of a long term illness or serious injury. When insurance companies wrongfully pull the net out from under unsuspecting policy holders, they are acting in bad faith.
A breach of contract claim may also involve other causes of action.
Every state recognizes that you can sue an insurance company for failing to settle a disability claim as set forth in the policy.
Many states also allow for recovery of damages resulting from these suits. This can include:
- Loss of business opportunity
- Harm to professional reputation
- Emotional hardship
- Economic damage beyond the limits stated in the policy
When the action is based on the breach of implied covenant of good faith and fair dealing (“bad faith”), you may have grounds for suing the insurer for bad faith insurance practices.
Breach of contract cases may also present grounds to sue for Deceptive Trade Practice Act violations and state Insurance Code violations. These actions can trigger eligibility to recover for punitive damages, lawyer fees and mental anguish in addition to recovering disability benefits.
Breach of contract lawsuits generally center on the language in the policy to establish what obligations each party had and whether each party met those obligations.
The standard of proof in a breach of contract action is a preponderance of the evidence:
You must show the court, through substantive evidence and witness testimony, that there is greater than 50% likelihood that the insurance company caused the damage or other wrong. The jury is instructed to determine which party overall has the most convincing evidence, and to return a verdict in that party’s favor.
When Your Claim Is Denied
If you file a claim and it is denied, it is your right to file an appeal of the denial. Your legal rights depend on whether you have a group or private long term disability insurance policy.
When your insurance company sends a denial letter, it must state the reasons for refusing to pay benefits. The appeal process begins with an administrative appeal. It may continue to litigation in Federal Court if the insurance company continues to deny the claim.
When appealing private disability claims, correct preparation is essential to success.
It is of utmost importance that you provide complete documentation of your disability to the insurance company. You must get the full support of your physicians to make sure that thorough, detailed records are fully presented for:
- Your treatment
- Functional limitations
Should you hire an attorney when appealing private disability claims?
Your right to appeal is ensured, but appealing private disability claims is a complex legal process. The insurance companies have a team of skilled attorneys and a deep pool of legal resources to fight your appeal.
Now is not the time to confront the insurance company on your own. There is too much at stake.
Your chances for winning your case are much stronger when you are represented by an experienced private disability lawyer. At Marc Whitehead & Associates, we have successfully gone up against the big insurance companies and intimately understand disability law. Although you may not have heard of our firm, your insurance carrier most likely has.
We serve those who need help appealing private disability claims.
These insurers are not immune from the insurance laws that protect your rights. At Marc Whitehead & Associates, we know how to handle insurance companies. We are a powerful advocate for consumer protection and the rights of the disabled.
No matter where you live in the U.S., we can personally and aggressively represent you and enforce your legal rights. If you have been denied benefits, consult with us at no charge. Ask us your questions about appealing private disability claims. Allow us to evaluate your case.
Appealing private disability claims for clients across the U.S., Marc Whitehead knows how to fight the insurance companies and win.
If you choose our firm to represent you, our first step is to appeal your denied claim to your insurance carrier. We will be armed with complete documentation and will lay the groundwork for further appeal.
We will be fully prepared when the insurance company tries to reject the claim again. When needed, we will take your insurer to trial before the court. Wherever it is possible to obtain benefits prior to litigation, we make every effort to do so. Your insurance company may settle the claim with the threat of litigation or the actual filing of a lawsuit.