A Phoenix Disability Lawyer Discusses Long-Term Disability Law
Most workers are covered under Social Security and if a physical or mental impairment renders them unable to work, they may apply for disability. Some workers aren’t covered under the Social Security system and/or even if covered, also have coverage through the Arizona State Retirement System (ASRS) or programs through their city or County employment. Also, many workers with private employers have coverage through Plans provided through their employment, including plans established pursuant to the Employment Income Security Act of 1974 (ERISA). These plans often require workers to also file for Social Security Disability Insurance Benefits (SSDIB) and reduce the amount paid by all or a portion of the SSDIB benefit. Your Phoenix disability attorney can explain the various Plan requirements, exclusions and offsets and assist you in fully developing the evidence to support your claim.
The Basis for Denial
Each claim is unique and each insurance company evaluates claims in its own manner. However, an experienced Phoenix disability lawyer will tell you that some common reasons for denial include:
- The existence of a pre-existing medical condition
- The medical record, including physician reports and test results, is inadequate or insufficient because it doesn’t address all of the important issues
- The claimant is not disabled within the requirements of the Plan
Although insurance companies have great power, a Phoenix disability attorney understands that they must act in good faith and provide an opportunity for appeal.
The essence of bad faith is that an insurance company refuses to pay for a legitimate claim. Some examples cited by a knowledgeable Phoenix disability lawyer include:
- Delaying making a payment indefinitely
- Intentionally making policy language confusing or ambiguous
- Encouraging and perhaps rewarding claim adjusters for denials
When presenting a claim under a private Plan, proof that the insurance carrier engaged in bad faith can result in the award of significant damages.
The Appeal Process
The specific process of appeal is different with respect to the different type of claim presented. For claims presented under ERISA the Plan must permit 180 days from receipt of the denial of a claim to present an appeal, at least for the initial denial. Other claims have different appeal times. As Phoenix disability lawyer Alan Schiffman cautions, it is essential to know the time limits to appeal and to fully prepare the evidence for the appeal because judicial review if often limited to the administrative record.
Contact a Phoenix Disability Lawyer for Legal Advice
Insurance company representatives know every avenue available to the company to deny a claim. Protect your rights and level the playing field by retaining experienced and knowledgeable counsel. Call Schiffman Law Office, P.C., a Phoenix disability law firm at 602-266-2667 or 1-800-545-7372.