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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 purchase 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) insurance policies that are designed to replace lost income for 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 company might cite for denying your claim. Any disability insurance denial letter should state why the claim was denied. Below are some of the most common reasons disability insurance claims are denied:
Non-Medical Requirements
For each claim, Principal Financial Group must verify that the employee is eligible for disability insurance benefits. To qualify for disability insurance benefits, an employee must meet certain non-medical requirements, such as working a certain number of hours per week prior to the onset of disability or being an “active employee”. The term “active employee” is defined in each individual’s policy, but here is an example from an ERISA disability case in the U.S. federal courts). If you do not meet the non-medical requirements in your disability insurance policy, Principal Financial will deny your disability claim.
Medical Requirements
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, doctor 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 documentation to support your insurance claim will result in a claim denial.
Medical Reviews and Independent Medical Examinations
In some cases, Principal Financial may conduct a more thorough investigation of a disability claim. It is not uncommon for the insurance company to request a consultation with a vocational expert or a medical review of your file by the Principal’s medical director. Your claim may be denied if they determine that the evidence does not support your reported symptoms and limitations.
Principal Financial Group may also have you undergo an “independent” medical examination by an “independent” physician. However, this “independent” doctor is paid by Principal Financial, so the doctor has a motive to side with the insurance company. We believe a more accurate name for this part of a disability claim would be a mandatory medical exam.
Video Surveillance
Insurance companies like Principal Financial have also been known to conduct surveillance on claimants, often hiring investigative firms to follow a claimant and record their activities, especially if 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 is used to justify a claim denial.
Social Media Surveillance
Another common surveillance tactic in disability claims 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 deny or terminate your claim. You should check your privacy settings and ask friends and family not to tag you in any photos.
The frequency with which an insurance company verifies a claimant’s current disability status depends on the applicable 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 that 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. When an insurance company denies your claim, you have the right to appeal the decision. Many claimants are already overwhelmed by the claims process and choose to hire an experienced attorney for legal advice and assistance with the administrative appeal process. Under most policies, you or your attorney only have 180 days to file an appeal, so you need to contact an attorney as soon as possible. Most attorneys offer a free consultation to help you determine if the attorney-client relationship is right for you.
Do I Need to File an Appeal?
If you have a group insurance policy through your employer, your claim is likely governed by the Employee Retirement Income Security Act (ERISA). Under ERISA disability law, you must exhaust your administrative appeal rights with the insurer before filing 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 but are governed by state law. In a non-ERISA case, you may be able to file a lawsuit without going through the administrative appeals process.
Hiring a Principal Financial Group Disability Lawyer
Our team typically receives a call from a claimant who has received a denial letter from Principal Life in their claim for short- or long-term disability benefits and wants to appeal. The denial could be from the initial application where no benefits were ever 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.
How the Ortiz Law Firm Can Help with Your Claim Denial
Nick Ortiz is an experienced disability attorney and the founder of the Ortiz Law Firm. Mr. Ortiz has provided and offers the following legal services for disability claimants who 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;
- An ERISA appeal of a Principal Life denial of disability benefits; and
- A federal lawsuit or complaint against Principal Life for the wrongful denial of disability benefits.
Request a Free Consultation
If you have a claim against Principal Life for the wrongful denial or termination of long-term disability benefits, call the Ortiz Law Firm today at (888) 321-8131 for a free consultation with an experienced disability attorney. Our legal team is standing by to answer your questions, 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 disability insurance or have recently purchased a policy, our firm can help you understand what you are entitled to and whether there are deficiencies in your coverage that could result in 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 to your situation.
Some of the aspects of your policy that we will review include:
- Total versus residual disability;
- Own occupation versus any gainful occupation;
- Mental and nervous disability benefit limitations and
- Benefit limitations for self-reported conditions.