Nearly one in five U.S. workers will become disabled and remain unable to work for a year or more before they reach the age of 65. Fortunately, professionals can obtain long-term disability insurance coverage to protect their income in the event of a disabling accident or illness. Principal Life Insurance Company, which is part of the Principal Financial Group, sells long-term disability (LTD) policies that are intended to replace income lost by disabled policyholders. Unfortunately, Principal Financial Group does not always pay disability income benefits when it should and has been known to deny legitimate long-term disability claims.
Reasons for Principal Disability Insurance Denials
There are a variety of reasons that Principal or any other major disability insurance companies could cite to deny your claim. Each disability insurance denial letter should state the specific reason the insurance claim was denied. Below we discuss some of the most common reasons disability insurance claims are denied:
For each claim, it is necessary for Principal Financial Group to verify that the employee is eligible for disability insurance benefits. In order to qualify for disability insurance benefits, an employee must meet certain non-medical requirements, like working a specific number of hours each week prior to the onset of disability or being an “active employee” (which will be defined in each individual’s specific policy, but here is an example from an ERISA disability case in the United States federal courts). If you do not meet the non-medical requirements laid out in your disability insurance policy Principal Financial will deny your disability claim.
Principal Financial disability insurance policies also have specific medical requirements that a claimant must meet in order to receive disability benefits from the insurance company. Many resources are used to help verify disability claims, such as a statement from the claimant, physician and hospital records, Attending Physician’s Statements (APS), and home visits or field interviews conducted by the insurance company. Failure to provide the necessary medical records and documents to support your insurance claim will result in claim denial.
Medical Reviews and Independent Medical Examinations
In some cases, Principal Financial may decide to conduct a more in-depth investigation of a disability claim. It is not uncommon for the insurance company to order a consultation with the Principal’s disability nurse and vocational consultant, or a medical review of your file by the Principal’s medical director. If they determine that there is no evidence to support your reported symptoms and limitations your claim will be denied.
Principal Financial Group may also have you attend an “independent” medical examination with an “independent” physician. However, this “independent” doctor is paid by Principal Financial, so the physician has a motive to side with the insurance company. In our opinion, a compulsory medical examination would be a more accurate name for this part of a disability claim.
Insurance companies such as Principal Financial are also known to conduct surveillance on claimants, often hiring investigative companies to follow a claimant and record their activities, particularly when they have scheduled an IME that you are required to attend and they know that you will be out and about. This surveillance video becomes part of your claim file and will be used to justify a claim denial.
Social Media Surveillance
Another common surveillance tactic used in the disability claims process is to review the claimant’s social media accounts. Any social media posts, photos, or video surveillance that contradicts your reported symptoms and limitations could be used to wrongfully deny or terminate your claim. You should check your privacy settings and ask friends and family members not to tag you in any photos.
The frequency of an insurance companies’ verification of a claimant’s current disability status depends on the controlling policy’s definition of “disability”, the claimant’s medical condition(s), and the prognosis of the claimant’s medical condition(s). Most insurance companies, including Principal Financial, will contact claimants at least once every 18-24 months to verify their condition has not changed.
Appealing a Denied Principal Financial Disability Claim
Do not lose hope if you have received a claim denial letter from Principal Financial. If an insurance company has denied your claim you have a right to appeal the decision. Many claimants are already overwhelmed with the claims process and decide to retain an experienced attorney for legal advice and to help with the administrative appeal process. Under most policies, you or your lawyer only have 180 days to submit an appeal, so it is important that you contact an attorney as soon as possible. Most attorneys offer a free consultation so you can determine if the attorney-client relationship will be the right fit for you.
Do I Have to File an Appeal?
If you have a group Principal insurance policy through your employer, your claim is likely governed by the Employee Retirement Income Security Act (ERISA). Under ERISA disability law you are required to exhaust your administrative appeal rights with the insurer before you can file an ERISA lawsuit. However, the claims of those with individual disability insurance policies or those with a government or church employer are not governed by ERISA law and are instead governed by state law. In a non-ERISA case, you may be able to file a lawsuit without having to go through the administrative appeal process.
Hire a Principal Financial Group Disability Attorney
Our team will usually receive a call from a claimant after they have received a denial letter from Principal Life in their claim for short-term or long-term disability benefits and want to appeal. The denial could be from the initial application with no benefits ever being paid, or the denial could be a termination of benefits (also called a cessation or cut-off of benefits). Cessation claims can also be appealed. We don’t often handle short-term claims, but we may be able to help if you have a long-term disability policy as well.
How Ortiz Law Firm Can Help with Your Claim Denial
Nick A. Ortiz is an experienced disability attorney and founder of the Ortiz Law Firm. Mr. Ortiz has provided and offers the following legal services for disability claimants that have a group long term disability insurance policy purchased through an employer or an individual disability income policy purchased from Principal Group:
- The appeal of a Principal Life denial of disability benefits;
- The appeal of a Principal Life termination of disability benefits;
- ERISA appeal of a Principal Life denial of disability benefits
- A Federal lawsuit or complaint against Principal Life for the wrongful denial of disability benefits;
- Negotiation of a buyout of a Principal Life long-term disability insurance policy in the form of a lump sum settlement.
Request a Free Consultation
If you have a claim against Principal Life for the wrongful denial or cessation of long-term disability benefits, call the Ortiz Law Firm today at (888) 321-8131 for a free consultation with an experienced disability lawyer. Our legal team is standing by for your call and is ready to answer any questions you may have, or our team can set up a call between you and one of our attorneys. You can also fill out the contact form on this page to request a consultation with one of our attorneys.
Request a Free Policy Evaluation
If you are considering purchasing a disability insurance policy or have recently purchased a policy, our firm will help you understand what you are entitled to and whether there are deficiencies in your coverage that could lead to a denied claim. It is easy for individual policyholders who are not trained to read insurance policies to misread or misunderstand the disability policy. As part of our evaluation, one of our attorneys will explain what everything means to you and how your coverage applies in your situation.
Some of the aspects of your policy we will review include:
- Total versus residual disability;
- Own occupation versus any gainful occupation;
- Mental and nervous disability benefit limitations; and
- Self-reported conditions benefit limitations.