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As a disability lawyer, I’ve helped countless clients navigate the complex world of disability insurance claims. One company that comes up in my practice area is Zurich American Life Insurance Company (Zurich or Zurich American).
Zurich American Life Insurance Company is a part of the Zurich Insurance Group. Zurich is a widely respected and major insurer in the insurance market, offering a variety of insurance policies, including disability insurance. Disability insurance replaces a portion of your income if you are unable to work due to a disability.
In this article, I will provide an overview of the disability insurance claims process at Zurich American. I will also share some key insights on how to deal with potential challenges that may arise. This guide is not a substitute for legal advice, but it can help you understand your rights and make informed decisions.
Filing a Disability Claim with Zurich Insurance Company
Filing a claim for long-term disability benefits with Zurich American is fairly straightforward. You fill out a claim form, which includes sections for you and your treating physician to complete. The information on this form will help determine your eligibility for benefits.
All the information you provide must be accurate and complete. Also, make sure that your doctor provides a comprehensive medical report that illustrates your disability and its effect on your ability to work. This information plays a critical role in the insurer’s decision-making process.
In 202, Aflac acquired Zurich North America’s group benefits business, which includes some group disability products. Zurich American Life Insurance Company will continue to administer certain group disability products and absence management services. However, Aflac of New York and Aflac of Columbus now serve as plan administrators for some Zurich disability plans.
The Challenge of Denied Claims
Unfortunately, Zurich does not approve all of the disability claims it receives. Like any insurance company, Zurich American uses a rigorous evaluation process to determine the validity of disability claims. There are a variety of reasons why Zurich may deny a claim. These reasons range from insufficient medical evidence and pre-existing conditions to failure to comply with the terms of the policy.
However, sometimes Zurich wrongly denies valid disability claims. Some claimants meet the definition of “disability” or “total disability” and still receive a claim denial. I’ve seen numerous cases where Zurich American has denied a legitimate claim, leaving the insured in a difficult situation.
The Definition of Disability
You must meet your policy’s definition of disability in order to receive benefits. Here is an example of how Zurich defines “disability”:
“During the elimination period and the first 24 months benefits are payable, you are disabled when we determine that:
- You are unable to perform the material and substantial duties of your regular occupation due solely to your sickness or injury.
- You are under the regular care of a physician; and
- You have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.
After monthly payments have been payable for 24 months, you are disabled when we determine that due to the same sickness or injury:
Click here to read the full Zurich disability insurance policy.
- You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.
- You are under the regular care of a physician; and
- You have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.”
Navigating a Zurich Insurance Company Disability Denial
If you find yourself with a denied claim, do not panic. There are ways to appeal this decision. First, review the denial letter carefully to understand the company’s reasons for the denial. It’s important to build a solid case to counter each of these reasons in the appeals process.
As an attorney who specializes in this area, I often recommend seeking professional help at this stage. Legal representation can be invaluable in building a strong appeal. An attorney can help you gather additional medical evidence and professional opinions, and provide the necessary legal arguments.
Working with a Zurich Disability Lawyer
Involving a disability insurance attorney in your appeal process can dramatically increase your chances of a successful appeal. As an attorney, I can thoroughly review your policy, the reasons for the denial, and your medical records.
My role goes beyond gathering documents and drafting appeal letters. I am a strategic partner who knows how to navigate the insurance landscape. I can effectively negotiate with the insurance company on your behalf. If necessary, I can represent you in a lawsuit against the insurer for wrongful denial of benefits.
Litigation Against Zurich American Life Insurance
Sometimes a denied claim may violate the terms of the policy or constitute bad faith. A bad faith denial could be grounds for a lawsuit. Litigation may be an option if your appeal is unsuccessful and you believe Zurich has wrongfully denied your claim.
It’s important to understand that this is an important step. You must have a strong case based on solid evidence to succeed in the United States District Court.
In a lawsuit, our goal is to prove that the insurer has breached the contract. Zurich. like any other insurer, must evaluate claims objectively and in good faith. Proving a wrongful denial may involve:
- Proving that Zurich American intentionally misinterpreted medical reports.
- Failed to conduct a thorough investigation; or
- Delayed your claim without cause, among other things.
Claimants may be able to recover benefits due in the form of a lump sum settlement. Claimants may also be entitled to other damages, including attorneys’ fees. If you are unsuccessful in the district court, you may appeal the decision to the Court of Appeals.
Contact Us for a Free Case Evaluation
Please remember that this information is general, and individual circumstances may vary. If Zurich denies your claim for long-term disability insurance, I recommend that you contact an attorney who specializes in disability insurance law. This will allow you to discuss the specifics of your disability and how it prevents you from working. Call the Ortiz Law Firm at (888) 321-8131 for advice tailored to your situation.
