Overturning Claims Denials

Disability insurance claim denials can be extremely difficult to reverse. Insurance companies expertly document their reasons for denying disability benefits, and often do this behind the scenes, utilizing multiple in-house doctors, “independent” medical exams, and the like.

Many professionals facing a claim denial initially think that they can “work it out” with their analyst or that it was a “mistake” that can be easily corrected with a note from their doctor, or an updated test result. They forget that, when it comes down to it, their financial interests directly conflict with the insurance company’s financial interests, and this is especially true if your benefits have been denied or terminated.

We commonly consult with professionals who tried to handle a denial themselves (or who hired lawyers inexperienced in the industry) and ended up going through months and months of prolonged and unnecessary “reconsideration” and “appeals” before receiving yet another denial. Sometimes the company use this time to shore up their positions, and then reveal that its in-house doctors have prepared multiple reports/opinions discounting your restrictions and limitations. They also use it as an opportunity to overwhelm your treating doctor with “follow-up” questions and test whether your doctor is going to stand by you or remove himself/herself from the process if it looks like things are headed to court. Another common tactic is to pass your claim from analyst to analyst, to supervisor, etc. until you just give up, or find yourself several months removed from the claim denial with no benefits coming in, and no progress being made.

These are not things that you want to be facing alone. Insurers have been denying professionals’ claims for decades now, and they are very adept at manufacturing bases for denials and stringing insureds along until they settle for much less than the claim is worth or abandon the claim entirely. If your claim is denied or terminated, you should contact an experienced disability attorney immediately.

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