Law Offices of John D. Ameen
  • 3860 W Commercial Blvd., Tamarac, FL 33309
  • 800-555-4011 800-555-4011 (24/7/365)

 

Disability Insurance Claim Denial and Appeal

Disability Insurance Lawyer Serving Broward County & Palm Beach County

Have you been denied disability benefits through your employer or private insurer? We can appeal your claim.

Law Offices of John D. AmeenDid you know that a majority of disability insurance claims nationwide are denied in the initial application process?

Even if claims are appealed and lost, a high percentage end up getting approved when a second appeal is filed.

The scales will tip even more in your favor if you have an experienced legal team by your side fighting to protect your rights and making sure you get the benefits you deserve.

At the Law Offices of John D. Ameen, P.A. we have a proven track record throughout South Florida of obtaining fair recoveries for our clients.

Our founding attorney John Ameen has successfully resolved disability insurance disputes for over 20 years through negotiation, and litigation when necessary.

In the fields of disability insurance, Mr. Ameen exclusively represents those who have either purchased disability insurance through a private insurer or receive benefits through their employer — and are now facing a denial of coverage.

Call us 1-800-555-40111-800-555-4011 for a Free consultation or fill out our case review form. We will review your policy and help gather the necessary documentation to build a winning claim.

About Our Firm

As a small boutique law firm, we provide a level of personal attention and care that is difficult to find at larger firms.

We believe that tremendous physical, emotional and financial hardship should be met with compassionate counsel and aggressive advocacy.

We assist disability insurance claimants with any issues that may arise in the claims application and appeals processes. John D. Ameen, P.A. has the knowledge and resources to deliver the best possible outcome for you and your family through:

  • Gathering medical evidence to prove your disability.
  • Guiding you through the steps of filing a claim or appeal.
  • Prosecuting bad faith insurance company practices.

Understanding Disability Insurance

Law Offices of John D. Ameen56 million people nationwide suffer from physical, psychological or emotional disabilities, according to national Social Security statistics.

If someone can no longer earn a paycheck on their own due to an unfortunate injury or illness, disability insurance, also known as income replacement benefits, can provide a much-needed lifeline.

Despite paying premiums faithfully every year, it’s not always easy to retrieve the benefits you are entitled to. The claims process can be complex and insurance companies will sometimes deny or delay valid claims.

The process of appealing your disability insurance claim denial will vary depending on whether you have purchased disability insurance through a private insurer or obtained benefits through your employer.

If your employer provided you with a Long-Term Disability Plan as an employee benefit, a federal law known as ERISA (Employee Retirement Income Security Act) applies. If you purchased Long-Term Disability insurance directly from an insurer or insurance agent, the laws of Florida will most likely apply.

Common conditions that qualify as disabilities include:

  • Physical disabilities such as arthritis, spine, neck and back disabilities, carpal tunnel, nerve impingement.
  • Mental and emotional disabilities, including anxiety disorders, post-traumatic stress disorder (PTSD), depression and cognitive impairments.
  • Nervous system disabilities and chronic pain disabilities, including reflex sympathetic dystrophy (RSD), fibromyalgia and chronic fatigue syndrome.
  • Disabling diseases such as HIV/AIDS, lupus, ALS, cancer and Parkinson’s disease.

Employer Disability Insurance, aka ERISA

Law Offices of John D. AmeenIf you depend on long-term group disability benefits from a private-sector an attorney can greatly help you with getting disability benefits approved are most likely being regulated by ERISA.

The Employee Retirement Income Security Act of 1974 (“ERISA”) is a complex federal law that was originally designed to protect employees’ access to disability in the event of a serious injury or prolonged illness.

  • Complicated requirements and strict deadlines imposed by ERISA can confuse claimants.
  • ERISA, being a federal act, takes precedence over state laws that would normally provide a higher level of protection to disabled plan participants.
  • Most of ERISA’s plan administrators are usually large insurance companies.

These are just some of the reasons why it’s so important to have an Attorney like John Ameen on your side to level the playing field and protect your rights.

Filing an ERISA Claim

When you were hired, you probably received a large packet from human resources outlining your disability plan. There is also a separate document that outlines the policy.

John D. Ameen, P.A. will review both these documents to make sure your medical issue, disability or illness is covered by your plan, and that the specific steps outlined in the policy are followed when filing a claim.

After the claim is filed, a decision should be reached within 45 days.

The ERISA Appeals Process

Law Offices of John D. AmeenIf your ERISA claim has been denied, the insurance company must provide a detailed explanation in writing as to why the claim was denied and information on the appeal process.

To appeal the denial, you are required to exhaust all administrative remedies before you can file a lawsuit.

You have 180 days to file an appeal in writing. If sufficient information is not submitted within this timeline, you may be forever barred from introducing documentation to prove your disability.

John D. Ameen, P.A. can help you meet this deadline and gather evidence to help your case. This may include:

  • Comprehensive Financial, Employment and Medical Records.
  • Physician’s Letters.
  • Statements of Co-Workers, Colleagues and Friends.

One thing to keep in mind is that not all long-term disability plans are governed by ERISA. Sometimes insurance carriers claim your benefits are governed under ERISA so they can subject you to their strict deadlines and guidelines.

Attorney Ameen will make sure to fully vet your plan and policy to make sure you are not being taken advantage of.

Private Insurance Disability Claim

Many high-income professionals choose to purchase a private disability insurance plan from either an insurance agent or group association to protect them if they can no longer perform the duties required in their profession.

Before filing a claim, it’s important to carefully review the claims procedures outlined in your insurance policy. After you submit your claim, you may be asked to undergo an “independent” medical examination by someone chosen from your insurance carrier.

Before agreeing to this, it’s important to verify that the carrier has a right to conduct the exam per the policy language. Attorney Ameen can help supervise this process.

In Florida, a private disability insurer has 45 days to decide your claim after you file it.

Holding the Insurance Company Accountable for a Denied Disability Claim

If your private disability claim has been denied, you may not have to go through an exhaustive administrative appeal process that is required through employer based programs under ERISA.

Private disability insurance is a “contract” between you and your insurer, so if the insurer breaches that contract in any way, you can sue them directly in state or federal court.

You can also pursue a bad faith lawsuit if you believe the insurance company engaged in unfair practices to deny or delay your claim.

In Florida, if you are suing your insurer, the outcome will be determined in a trial by a jury of your peers.

Examples of bad faith practices include:

  • Deliberate misinterpretation of records or policy language to avoid coverage.
  • Failing to thoroughly investigate a claim in accordance with company’s procedures.
  • Misclassifying disability.
  • Trying to settle your claim for less than what a reasonable person would expect to receive.

At John D. Ameen, P.A. we have extensive experience obtaining disability benefits.

If you have been denied an ERISA disability insurance claim or a claim through a private insurer, we can help you appeal. Give us a call 1-800-555-40111-800-555-4011. for a Free consultation or fill out the form below.

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Law Offices of John D. Ameen

  • 3860 W Commercial Blvd., Tamarac, FL 33309
  • 954-763-4950 954-763-4950