San Francisco Insurance Law Blog

An insurance denial is not the end

You try to use your long-term disability insurance, but you get denied. Since you know you are disabled, you're shocked. Is this all you can do? Is that the end of it?

It's not. Appeals are possible and even common. You may be able to make multiple appeals. Do not assume you are out of options -- or out of luck -- just because you get denied at the beginning.

Will a spinal cord injury ever heal?

A spinal cord injury can happen in a fraction of a second. You fall from a ladder at work and strike the ground. You get into a car accident as someone else runs a red light. You take a bad hit while playing football and cannot get off the field under your own power. There are countless examples.

In that fraction of a second, your life can change forever. Depending on the location and severity of the injury, you may never walk again. You may never have function below your neck. You could need constant care for life.

Your rights under the Employee Retirement Income Security Act

Retirement plans are extremely important for ensuring that all workers are financially secure for their entire lives. Many workers know that they are putting aside funds for retirement, but they often do not have a lot of information about their plans.

This is why the Employee Retirement Income Security Act (ERISA) was enacted. ERISA was put in place in 1974 to ensure that employee benefit plans were regulated and so that employees did not fall victim to poorly managed plans. The following are some of your rights as an employee under ERISA.

How do you talk to your doctor about disability?

You've made the decision that you need to file for long-term disability -- and it hasn't been easy. Like many other people facing a similar decision, one of the hardest things to do seems to be having a very necessary discussion with your doctor to get their support.

Here's how to start:

Why do long-term disability claims get denied?

Long-term disability insurance is supposed to be there to protect you and provide you with an income when you can't work -- but far too many people find out that even though they've faithfully paid their policies for years, the insurance company simply isn't there for them when they need it.

There claims come back denied. Here are some of the reasons that your long-term disaiblity claim might be refused:

What long-term disability insurance typically covers

No matter how healthy you currently feel, there is always some possibility of becoming ill or getting injured. If you become seriously unwell, you will require costly medical treatment and will not be able to gain an income for a significant amount of time. To protect against this risk, it is advised that employees cover themselves with long-term disability insurance, otherwise known as LTD insurance.

Many employers offer LTD insurance to employees as part of their benefits packages. This is often offered to attract and retain employees, and to show employees that their well-being is prioritized by the company they are employed by. Some people decide to cover themselves with LTD insurance by paying annual premiums.

You're not powerless against your insurance company

You trusted your insurance company. You made those monthly payments because you believed that they would be there for you when you needed them. Then you filed a valid claim, and they denied it.

You can't believe it. You feel like they robbed you, essentially. They took your money and then refused to honor the obligations that came along with that money.

What law can help protect my retirement plan?

As an employee of any age, you should be thinking about how your employer is contributing to your retirement plan. This is something that younger generations tend not to concern themselves with. However, many people approaching retirement begin to realize that they should have placed more importance on it throughout the entire duration of their careers.

You may be wondering if there are any laws and regulations in place to ensure that employers invest in and protect their employees' retirement plans. One such law is the Employee Retirement Income Security Act (ERISA). This act was put into place in 1974 to protect employees.

Tricks of the disability insurance trade: Deny until death

What's one sure-fire way insurance companies can avoid paying out a long-term disability claim? When the policy holder dies before he or she can collect.

That seems rather obvious and makes sense -- until you realize that some long-term insurance companies will frequently find ways to delay payment on a long-term disability policy as long as possible, basically hoping that the insured will either give up or die.

Can you protect yourself from a faulty insurance policy?

Having an adequate insurance policy is something that can provide you with more confidence and put your mind at ease because you can secure some form of support and protection in case you are involved in certain accidents. However, if you are struggling with getting the full benefits out of your insurance policy in California because they are refusing to honor the terms of your agreement, you could be facing a difficult battle. 

Familiarizing yourself with the terms and conditions of your insurance policy is central to your ability to know under what conditions it will function. If you have holes in your coverage and are unable to find a customized plan that is adequate for your lifestyle and the unique risks you face, you may wish to look into alternative policies that can provide supplemental protection and give you the peace of mind you need. 

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