Long term disability insurance provides financial protection, offering income replacement when medical conditions prevent you from working. Federated Insurance is among the disability insurance companies offering such policies. However, having an insurance policy that may cover you does not automatically guarantee claim approval.
In this article, we will examine the potential scenarios where a disability claim could be denied by Federated Insurance and discuss the subsequent administrative appeal procedures. If you need specific legal advice, please consult a qualified long term disability attorney.
Founded in 1904, Federated Insurance has a long-standing history of providing insurance solutions to businesses and individuals. While it initially started as a mutual insurance company serving the retail hardware industry, it has since diversified to offer a broad range of insurance products, including long term disability insurance.
The Anatomy of Claim Denials
Filing for disability benefits is more than just filling out a form; it’s a complex procedure influenced by various laws, such as the Employee Retirement Income Security Act (ERISA) for employer-sponsored policies.
To receive benefits, you must meet the definition of disability and any other requirements stated in your insurance policy. Here is an example of how a Federated Insurance policy defines “total disability”:
“You’ll be considered totally disabled if because of sickness or injury:
- You are under the regular and personal care of a physician; and
- You are unable to perform the substantial and material duties of your regular occupation: and
- You are not engaged in any other occupation for wage or profit; and
- You are unable, after the first 3 years of your total disability, to work in any occupation for which you are suited through education, training, or experience.”
Common Denial Reasons
- Unsubstantiated Medical Claims: One of the leading causes of denial is a lack of sufficient medical evidence to support your claim of disability.
- Contractual Exclusions: Every policy contains clauses that exclude certain conditions from coverage. If your disability falls under these exclusions, your claim will likely be denied.
- Late Reporting: Policies often stipulate a required time frame to report your claim or provide Notice of Disability. Failure to report your claim within the required time frame can lead to claim denial.
- Documentary Inconsistencies: Any inconsistencies in your medical records, work history, or other documents can serve as grounds for denial.
Roadmap for Appeals
The denial of a disability claim is not the end of the road. You have the right to appeal the decision, but you must be careful and methodical during the appeal process.
Evaluate the Denial
Your first step after receiving a denial letter from Federated Insurance is to understand why the denial occurred. The denial letter will outline the specific reasons that will guide your appeal strategy.
Assemble Supplementary Evidence
A strong appeal often involves gathering additional information that addresses the gaps or weaknesses identified in the denial letter. This might include more in-depth medical evaluations, expert opinions, or witness statements.
Legal Assistance: Don’t Go It Alone
The appeal process can be fraught with tricks and traps that could further jeopardize your claim. Consulting with a long term disability attorney can help you understand the landscape and strategize effectively.
Submitting Your Appeal
Take time to obtain the evidence needed to support your appeal letter, but be sure to file your appeal within the timeframe outlined in your denial letter. Your appeal package should include new evidence, required forms, and a legal brief if you have sought attorney assistance.
Await a Decision
Upon receiving your appeal, Federated Insurance will re-review your claim, considering the new evidence. Regulatory guidelines dictate the timeframe within which they must reach a decision.
A denial from Federated Insurance for a long term disability claim is discouraging, but this is no time to give up. The key to a successful appeal lies in understanding the nuances of your policy, the reason for the denial, and the legal landscape that governs disability claims.
Involving a specialized long term disability attorney can offer invaluable expertise in navigating these challenges and potentially securing the benefits you need. We welcome the opportunity to evaluate your claim and assist you in the appeal process—call (888) 321-8131 to schedule your free case evaluation today.