My Disability Claim Was Just Denied – What Should I Do Now?

Be Mindful of What You Say.  
Usually, you will first find out that your insurer is denying or ending your disability benefits via a telephone call from the claims consultant who analyzed your claim. You should be aware that the consultant will likely be taking detailed notes about anything you say during that call.  Therefore, even if you are justifiably upset or angry, be very mindful of what you say.  Anything you tell the consultant will likely be written down and saved in your file.

Take Notes.  During the call with your consultant, be sure to take your own notes.  You don’t have to ask a lot of questions at this stage, but you do want to make sure to record whatever information the consultant gives you.

Read the Termination/Denial Letter Carefully.  Following the phone call, you should receive a letter from the insurance company stating that it has denied your claim or discontinued your benefit payments.  According to most state and federal law, the letter should have a detailed explanation of the evidence the company reviewed and why the insurer thinks that evidence shows you aren’t entitled to benefits.  When you receive the letter, read through it carefully.  Make notes on a separate document about any inaccuracies you identify.

Keep a Copy.  Be sure to keep a copy of the denial or termination letter, as well as the envelope it came in. Make a note of the date on which you received the letter, because the date the letter was actually received could be important to your legal rights in the future.  You should also scan the documents electronically or make a photocopy for your file, just in case the original denial letter gets lost or damaged.

Contact an Attorney.  Once you find out that your claim has been denied or terminated, you should contact a disability insurance attorney.  Some physicians and dentists attempt to handle an appeal of their claim on their own, but we strongly suggest at least consulting with a law firm.  Every insurance  company has its own team of highly-trained claims analysts, in-house doctors, and specialized insurance lawyers to help it support the denial of your claim.  Having your own counsel can level the playing field by making sure you know your rights under your policy and what leverage the applicable law provides you, and help you avoid the common traps that insurance companies lay for claimants on appeal.

Don’t Delay.  In many circumstances, you will only have a limited amount of time to appeal the insurance company’s decision, so you will want to contact an attorney and start working on the appeal as soon as possible.  Particularly in claims governed by the federal law ERISA, the clock starts ticking as soon as you find out your claim has been denied or terminated.

Plan Your Response Carefully.  It’s usually best to contact an attorney before you respond to the denial letter, to avoid saying anything that could prejudice your appeal.  For instance, if you have a policy that is governed by ERISA, and you submit some additional information, the insurance company may not allow you to submit any additional information after your initial response.

Gather Supporting Documentation.  Before you meet with potential disability insurance lawyers, gather whatever documents you can to help them evaluate what’s going on with your claim.  Our firm will always want to review the insurance policy or policies.  We typically also like to see your relevant medical records and any correspondence between you and your insurance company.  If you aren’t able to locate this information, it could cause delays in starting the appeal process.

Don’t Go Back to Work if You Are Disabled.  If you are a physician or dentist who is totally disabled, you should not try to go back to work just because your insurance company thinks you don’t qualify for benefits.  Trying to practice when you aren’t in a physical or mental condition to do so could cause you to re-injure yourself or accidentally harm your patients.  And, of course, trying to work on patients after you’ve claimed that you are totally disabled can expose you to professional liability as well.  Also, if you attempt to return to work, it could impair your ability to collect your benefits upon appeal.

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