Claims Regulations and Coronavirus: How Your Claim Can Be Affected

With the coronavirus strain COVID-19 sweeping through the nation, the impact on disability insurance claims is still uncertain. Many courtrooms are still closed or modifying the way court is held. However, the Department of Labor (DOL) has not issued any new guidance on the claims procedures. Deadlines are still required to be maintained. This may create a longer than normal claims process for you. Here is what we know right now.

Updated DOL Regulations Took Effect in 2018

The Department of Labor announced a decision regarding the applicability of the April 1, 2018, Final Rule Amending Claims Procedure for Disability Benefit Plans. The new regulations require that you are given a clear explanation of why your claim was denied and the opportunity to respond, a copy of the appeals procedures, and that your claim is reviewed within a reasonable amount of time. A reasonable amount of time is defined as no longer than 45 days after receipt of the claim. If the insurance company decides they need more time to review your claim, they must provide you with a written statement before your 45 days initial claim period is over.

Your claim review period can be extended for up to two 30-day periods if it is necessary and beyond the control of the plan. An appropriate notice must be given to you in this situation as well. If these deadlines are missed, you are the claimant that has the right to pursue any available remedies under Section 502 (a) of the Employee Retirement Income Security Act of 1974.

Delays Due to Coronavirus

Updates to the regulations were meant to provide support to claimants who were not being treated fairly by the insurance companies by providing clarity by defining what a reasonable amount of time means for you and the insurance company. But what does this mean for you during a pandemic like a coronavirus?

• Difficulty obtaining in-person physical examinations: Most doctor’s offices have begun to resume regular office visits for non-COVID-19 patients. To maintain social distancing, appointment times are being spaced out, which means that you could have to wait an additional two weeks or longer. In smaller cities with only one specialist serving the entire population, appointments that cannot be handled via telemedicine, are seeing several weeks in delays for appointments. Receiving in-person examinations from your doctors is important to get your claim approved.
• Delay in receiving the necessary paperwork: As doctors’ offices open back up, the amount of paperwork needed to be completed has only grown over the last few months. The insurance companies require documents like Functional Capacity Evaluations (FCE) and Independent Medical Examinations (IME) to be completed by your doctors in order to process your claim. Receiving the paperwork, you need to submit your claim could be delayed, which is of great concern due to the timeline constraints.
• Delayed procedures: Many disabled workers must undergo corrective surgery as part of their treatment plan. While many hospitals are slowly opening up for non-life-threatening surgeries, there is a backlog of patients that have not been able to have surgery during the coronavirus crisis. Many claimants have been waiting well over 90-days for their surgery. Moreover, these delayed procedures could have caused more damage in your area of disability.
• Delayed claims processing: Most companies, including disability insurance companies, have decreased the amount of in-office personnel. Many claims adjusters are working from home, which brings its own set of challenges and distractions. Due to this unusual working environment, expect delays in claims processing.

How Will These Obstacles Affect My Claim? 

The short answer is we just don’t know yet. The DOL has not issued any updated guidance regarding deadlines. Think about using a disability attorney to help you through the claims process. The insurance companies and disability attorneys will be the first ones to know if and when the DOL issues new guidance. The attorneys for the insurance companies will be using any tactics possible to avoid paying claims. Hiring an experienced disability attorney can help you prepare the most substantial claim possible.

The Ortiz Law Firm offers a free consultation with no obligation to use our firm. During the call, you can ask any questions you have, and we will answer them. The Ortiz Law Firm has successfully represented people in disability cases across the United States. To see how we can help you win your long-term disability case, call us at (888) 321- 8131.