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Long-term disability insurance is an important financial safety net designed to provide income if you’re unable to work due to illness, injury, or other medical conditions. Primerica is a major player in this area, offering a range of policy options. While the goal is to provide peace of mind, there may be instances where a claim is denied.
The purpose of this article is to discuss the potential for claim denials with Primerica’s long-term disability insurance and the subsequent administrative appeals process. For tailored advice tailored to your individual circumstances, consult a qualified long-term disability attorney.
What is Primerica?
Founded in 1977, Primerica is a U.S.-based financial services company that offers a variety of products, including term life insurance, mutual funds, and long-term disability insurance. The company has a strong track record and is well respected for its financial services offerings.
Understanding the Potential for Claim Denial
When you file a disability claim, you’re entering a complex administrative process governed by federal laws such as the Employee Retirement Income Security Act (ERISA) if the policy is through your employer, or state insurance laws if you have an individual disability insurance policy.
Common Reasons for Denial
- Insufficient Medical Evidence: This is the most common reason for claim denials. The insurance company may argue that your medical records do not support your disability claim.
- Policy Exclusions: Certain conditions may not be covered by your policy. Always understand the limitations and exclusions outlined in your policy.
- Failure to Meet Elimination Period Requirements: Most policies have an “elimination period,” the length of time you must be disabled before benefits begin. Failure to meet this period could result in a denial.
- Surveillance Evidence: Insurance companies may hire investigators to conduct surveillance to verify the legitimacy of a claim. Evidence that contradicts your disability claim may be grounds for denial.
The Administrative Appeal Process
If you are faced with a claim denial, it’s important to understand the appeals process and act quickly, as there are strict deadlines for filing an appeal.
Step 1: Review the Denial Letter
The denial letter should state why the claim was denied. Understanding the reasons will help guide your next steps.
Step 2: Gather Additional Documentation
This may include more extensive medical records, test results, or even statements from coworkers or family members that support your inability to work.
Step 3: Consult an Attorney
Given the complexities involved, it’s wise to consult an experienced long-term disability attorney to guide you through the appeal process. An attorney can help you put together a strong appeal package and represent you during the appeal review process.
Step 4: File the Appeal
Submit the appeal to the insurance company before the deadline specified in the denial letter. This usually involves completing an appeal form or writing an appeal letter and submitting any additional documentation to support your claim.
Step 5: Wait for a Decision
Once the appeal is submitted, the insurance company will review any new evidence and make a decision on your claim or appeal. The timeline for this can vary, but generally must follow regulatory guidelines.
Get Help with Your Primerica Disability Claim
Navigating a disability claim denial can be a daunting and complex experience. Primerica, like all insurers, is required to adhere to legal standards when reviewing claims and appeals. If your claim is denied, it’s important to act quickly and thoughtfully in preparing an appeal.
Consulting with a long-term disability attorney can greatly increase your chances of overturning a denial and securing the benefits you’re entitled to. Call (888) 321-8131 to schedule your free case evaluation with long-term disability attorney Nick Ortiz.
