Many people carry disability insurance policies that will pay benefits if they become unable to work due to disability. These policies may be offered as part of a benefit plan at work, or an individual can buy his or her own personal disability-insurance policy.
The terms and benefits of these plans vary from policy to policy. However, most tend to follow a general pattern of a period of short-term disability (usually three to six months) followed by a period of long-term disability. Most policies will initially pay long-term disability benefits for some period of time (usually 24 months) that you are unable to perform your regular job. After that period, to continue receiving benefits you must prove that your disability prevents you from performing any job. There are frequently limits on disabilities due to mental-health conditions (often limiting long-term disability benefits to 24 months).
To qualify for these benefits, you must prove that you are “disabled” as defined by your insurance policy. Your insurance company will review your application and request information from your health-care providers to determine whether or not you meet its definition of disability.
As with any kind of insurance claim, the insurance company will decide whether to approve or deny your claim. And even if the insurance company initially approves your claim, it may decide at any time that you are no longer disabled, and terminate your benefits.
If your claim is denied, or if your benefits are terminated, you have the right to appeal. In this appeal, the insurance company will take a second look at your claim and issue another decision. Depending on your policy, you may have one or two opportunities to ask the insurance company to reconsider. Once the insurance company issues its final decision, you can file an appeal in court.
Many people decide to handle their appeals on their own. Unfortunately, this can backfire. In many cases, once you’ve exhausted all your appeals to the insurance company and your only remaining option is to file a lawsuit in court, you cannot add any evidence to your claim. The only evidence you can present in your lawsuit is the information that is already in your insurance file. If this does not include all the relevant medical or vocational information, it may be difficult to get a favorable decision in court. If your claim has been denied or your benefits have been terminated, you should contact an attorney right away.
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