Contact a Philadelphia Long Term Disability Appeal Lawyer Today to Fight Your Denial 

If your long-term disability claim has been denied or terminated, then you have the right to appeal the adverse decision under the Employee Retirement Income Security Act (ERISA). You should not hesitate to consult with a Philadelphia long term disability appeal lawyer because time is of the essence. Generally, you will only have 180 days from the date you receive notice of the termination or denial of your claim to file your appeal. It is also important to note that a failure to file a timely appeal may preclude you from filing a lawsuit under ERISA.

Pursuant to ERISA, you are required to exhaust all “administrative remedies” before filing a lawsuit, which includes filing the appeal(s) as specified in your applicable long term disability insurance policy. If you fail to file a timely appeal, you may be deemed to have waived your right to pursue benefits in court. You may have only one opportunity to appeal an adverse decision. Your disability insurance benefits are designed to provide you with a financial resource when you are disabled and unable to work, and a denial or termination can be detrimental.   As mentioned, time is of the essence when it comes to timely and effectively appealing a long term disability denial. Do not hesitate to contact Seltzer & Associates to discuss your long term disability appeal today! 

Will My Long Term Disability Insurance Denial Result in a Lawsuit?

Many claimants are apprehensive about initiating a lawsuit against the disability insurance company when disability insurance benefits have been denied or terminated. This is completely understandable and not something you should do on your own. The first step in the process is confirming that all administrative remedies have been exhausted during the appeal process, allowing eligibility to file a lawsuit. When eligibility is confirmed, you must proceed with filing a lawsuit against the disability insurance company in an appropriate jurisdiction and court, which can be overwhelming. A disability insurance attorney can make all the difference when sorting out the legal requirements of your case.

If your disability insurance claim has been unfairly denied or terminated, you should immediately contact a disability insurance attorney. Should you need to file an appeal or a lawsuit in relation to your disability insurance claim, it is crucial that you have an experienced disability insurance attorney to represent you. Seltzer & Associates can assist you through each step of the disability insurance appeal process, including pursuing a lawsuit if necessary to secure wrongfully denied disability insurance benefits.

Physicians Encounter Difficulty in Disability Insurance Claims

Insurance companies extensively scrutinize long-term disability claims filed by physicians, surgeons, and other high-earning medical professionals. Claims made by well-compensated medical professionals may result in substantial financial exposure for insurance companies when liable for disability insurance benefits. Insurance companies are, after all, for-profit businesses.

Insurance companies will not hesitate to deny a medical professional’s claim for disability insurance benefits when the opportunity arises. For example, an insurance company may refute that you are unable to work because they do not see objective evidence of your limitations in the medical records. However, we know that many of the impediments to a physician’s ability to work involve limitations that are difficult to measure objectively, such as pain or cognitive impairment. Denying a physician’s disability insurance claim protects the insurance company’s bottom line when the company should be protecting its claimants.

Medical Professionals Undergo Additional Scrutiny in Long-Term Disability Claims

Medical professionals are highly-trained experts with extensive knowledge and skill in their respective field. In order to limit financial liability, long-term disability insurance companies may assert that a physician is not totally disabled and able to work, even in a reduced capacity. If your disability insurance company makes unreasonable allegations regarding your ability to work, you should contact a Philadelphia long-term disability appeal lawyer to dispute this position. 

Your insurance company may claim you are able to work in another capacity as a medical provider based on your skill and experience. This may be true in some instances, though your policy may only require disability from your own or regular occupation. Defining a physician’s “own occupation” can be difficult for some medical professionals depending on the specialty or subspecialty and actual duties, which can open the door to claim denials or terminations. If your claim is being evaluated under the “any occupation” definition, insurance companies may argue that a physician is able to work in an occupation that may not be suitable based on factors such as age, experience, education, and prior earnings. In some cases, claimants should be deemed totally disabled, even though the insurance company may argue to the contrary.

Understanding the policy definitions and the type of disability insurance coverage you have is critical to effectively claiming disability insurance benefits and ensuring you are not denied any or all of the disability insurance benefits you are due. It is important to remember that as a skilled medical professional, your situation is often unique. We will give needed attention to the intricacies of your claim, including the medical and vocational information. We have significant experience representing disabled clients in the medical and dental professions, and we understand the demands of these occupations. Your disability insurance lawyer will be able to identify supportive evidence and facts from the record that demonstrate why a denial or termination should be overturned and whether to pursue litigation, if necessary.  

Seltzer & Associates scrutinizes disability insurance denials and terminations with the attention to detail and vigor necessary to hold companies accountable. Your Philadelphia disability appeal lawyer will have your back throughout the long term disability appeals process. 

A Lawyer at Our Firm Can Help You Start an Appeal for Your Insurance Denial or Termination

The appeals process is typically initiated at the time your claim is denied, or your benefits are terminated. A denial or termination notice may come at a time when you and your family need your disability insurance benefits most. The insurer should promptly provide a written, detailed explanation as to why your claim was denied or terminated. Your appeal must be carefully constructed to support your claim while exposing any flaws in the insurer’s review. The first step is to obtain a copy of the administrative record from the claim administrator. The administrative record or claim file should contain all of the information the company relied upon to make its adverse decision. This record may include hundreds or even thousands of pages of documents that should be carefully reviewed before finalizing and submitting your appeal. An experienced disability insurance law firm will obtain the administrative record and know what to look for when preparing an appeal. Let your disability attorney perform the task of reviewing thousands of pages of evidence and analyze the record to prepare your appeal.

When Appealing a Decision Regarding Your Long Term Disability Insurance, Timing is Critical 

It is important to understand the basis of the insurance company’s denial. Your disability insurance claim is governed by the terms, conditions, and limitations of your policy of insurance, as well as the applicable laws. When a disability insurance provider denies a claim for disability insurance benefits, it is required to provide a reasonable basis and explanation for its determination. A denial letter should contain an overview of the contractual and factual basess relied upon by the insurer to deny or terminate liability. Your Philadelphia disability appeal lawyer can review this explanation to assess its reasonableness and analyze it within the applicable legal framework.

It is also important to note that the appeal phase may be the last chance you have as a claimant to include supportive documentation in the administrative record. Once you have exhausted all administrative remedies, your file will be closed and any supportive information not included in the administrative record may be excluded from the litigation process. Any supportive information that becomes available after your claim is permanently closed may not be considered by the court in the event you file a lawsuit. Thus, claimants must think quickly and strategically during every stage of the claims process beginning at the moment you become injured or ill. What happens during one stage of the claims process will surely influence the next.

When it comes to long term disability claim appeals,  the 180 day time limit is not as generous a time frame as one may think. Filing an LTD appeal is a time-consuming and labor-intensive undertaking, especially when you are trying to ensure that the administrative record is properly documented with the most supportive medical and vocational information. It is never too early in the claims process to consult with a Philadelphia long term disability appeal attorney at Seltzer & Associates to ensure your claim is being presented in the strongest possible way, and to ensure you receive all long-term disability benefits you are due.

What Does It Mean to Exhaust Administrative Remedies?

When faced with a denial or termination of long term disability insurance benefits, you may notice a requirement to exhaust all administrative remedies before proceeding to litigation. You may be unclear as to the rights and remedies available to you. 

Your disability insurance policy should include information regarding administrative appeals and other remedies available to you. You may find yourself contacting your insurance agent to address the matter. However, any assistance from an insurance agent or representative is likely to be limited.

You should immediately consult with a Philadelphia disability appeal lawyer. Time is of the essence due to statutes of limitations and strict deadlines for filing your appeal. The experienced attorneys at Seltzer & Associates are highly experienced in pursuing legal remedies following a denial or termination. Additionally, our attorneys have extensive experience interacting with all major disability insurance companies on behalf of our clients. Let our knowledge and understanding of the complex disability insurance industry work for you. 

How Can I Prepare For My Long-Term Disability Appeal

You may wonder what knowledge and tools are necessary to fight against an adverse decision by your disability insurer. Some key components include:

  • Knowing your deadlines. Do not miss any!
  • Knowing and understanding the policy terms and definitions that were applied to your claim. Challenge any misapplied or misinterpreted provisions with the help of your Philadelphia long-term disability appeal lawyer. 
  • Gathering your medical records to ensure your claim is complete and accurate. Seltzer & Associates can help you build a strong record to support disability.
  • Make sure your treating physicians are aware of your claim for disability insurance benefits so they can properly articulate the medical basis for your disability claim. 
  • Obtaining a copy of the entire administrative record that your disability insurance company has built while evaluating your claim. The administrative file should include analyses and evaluations conducted by the disability insurance company with or without the assistance of hired experts.
  • Continue to seek appropriate medical treatment and follow the advice of your doctors for any disabling conditions. Your health is, of course, most important, and medical evidence is always crucial to meeting your burden of proving eligibility for disability insurance benefits, particularly after a denial or termination. Insurance companies can use a lack of regular medical care as a basis to deny or terminate your disability insurance claim.

Why You Need a Philadelphia Long Term Disability Appeal Lawyer to Handle Your Claim

Unfortunately, most claimants lack the knowledge and resources to challenge a large disability insurance company. At Seltzer & Associates, our team of disability insurance lawyers works with our clients to substantiate and effectively present their disability claims. We will thoughtfully analyze every aspect of a disability insurance claim, including the medical, financial, and occupation information submitted to the disability insurance company. We work to obtain all necessary medical documentation, and, when necessary, we will seek the involvement of well-qualified experts. Your disability insurance company will work vigorously to rationalize denying or terminating a claim for disability insurance benefits. Seltzer & Associates can help ensure that your disability insurance company fulfills its legal obligations to you.

Our legal team makes full use of the appeal process. We will address any deficiencies in the company’s investigation of your claim, including any contractual and legal issues. When an appeal is submitted, your Philadelphia long term disability appeal lawyer will continue to engage in dialog with the disability insurance company to help expedite a full, fair and objective review of your appeal. Contact us today to discuss how we can help you.