Before you apply for long term disability benefits, it’s important to know the changes that have been made to the laws that govern the insurance plans. New regulations were released and began on January 1, 2018. These new regulations add new due process rights for claimants that have been mistreated by insurance companies in the past. This is good news for claimants, and insurance companies have been appealing these new regulations since they were announced. As of 2020, the insurance companies have not been successful in appealing these new regulations. Here is a list of important items to note:
You Have a Right to Know Why Your Claim Was Denied
The new regulations require the insurance company to provide a complete explanation of denial in your denial letter and what internal protocols, rules, and guidelines were used to deny your claim upon request. Naturally, insurance companies do not want to share this information with claimants, so be sure to send your request by certified mail to have documentation that you made the request.
You Have a Right to Have Your File Reviewed By Impartial Experts
A common practice in insurance companies has been to have “in-house” doctors. This means the doctors are paid by the insurance company to review your file and give their expert opinion. The problem with this is obvious – the doctors are on the payroll of the insurance company and could be terminated for approving too many claims. Likewise, in-house doctors are not specialists in every possible case. It’s not appropriate for a rheumatologist to offer his opinion on a patient that is being treated by an oncologist. There was also a growing trend of providing an incentive. Claimants now have the right to have their claim reviewed by a person that is impartial to the outcome of the benefits claim.
You Have a Right to Timely Reviews of Your Claim File
Claimants now must be given timely notice of access to their claim files. This gives you the opportunity to review new information that has been added to your file and reviews by the insurance companies’ medical or vocational experts. The point of this rule is to allow you to respond to new evidence that may be negatively affecting your claim.
You Have a Right to Have Your Notices in Your Native Language
Another issue that claimants faced were letters being written in a language that was not the claimants’ native language. An example of this is providing notices to claimants that speak Spanish as their language in English only. The claimant would have to hire an interpreter to translate the notice. This, of course, could cause the claimant to miss a deadline or not understand the process and documents needed for the claim. The new ERISA has implemented safeguards for this by requiring insurance companies to provide notices in a culturally and linguistically appropriate manner. Even hiring customer service agents to assist claimants with translation.
You Have a Right to Pursue Claims in Court
Previously, the burden of proof to prove that an insurance company did not follow their own procedures when processing your claim was harder to prove. Now that ERISA has implemented so many procedural safeguards, it is much easier to document when the insurance company fails to provide your claim with an adequate review. Claimants now have the right to pursue a claim review in court, skipping an additional required appeal if the insurance company fails to comply with the procedure requirements.
These changes come as bad news to the insurance companies that make billions in profit each year on denying claims. Holding insurance companies more accountable is a giant step in the right direction to protect employees when it comes to long term disability benefits.
Navigating Long-Term Disability Claims with Expert Legal Assistance
Has your disability claim been denied? Don’t worry. At Ortiz Law Firm, we specialize in guiding clients through the intricacies of ERISA regulations. Our seasoned legal team is well-equipped to ensure you meet your claim deadlines, compile essential documentation, assist during field interviews, and provide strategic counsel to enhance your claim’s chance of success.
We operate on a contingency basis, meaning you owe us nothing unless we secure a favorable outcome for your case. This approach allows you to seek expert legal advice without the stress of upfront fees or unforeseen charges. Let our team handle the legal complexities, so you can prioritize your health.
We offer a free, no-obligation case evaluation. During this conversation, we welcome any questions about your claim. We represent claimants in disability claims across the U.S. Learn more about how the Ortiz Law Firm can champion your long-term disability claim by reaching out to us at (888) 321- 8131.