As a disability insurance attorney, I’ve helped countless clients through 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 Zurich Insurance Group. Zurich is a widely respected and major insurer in the insurance market, providing a variety of insurance policies, including disability insurance. Disability insurance replaces a portion of your income if you cannot work due to a disability.
In this article, I aim to provide an overview of the disability insurance claims process with Zurich American. I will also share some key insights about how to handle potential challenges that may arise. This guide should not replace legal advice but may help you understand your rights and make informed decisions.
Submitting a Zurich Insurance Company Disability Claim
Filing a long-term disability benefits claim with Zurich American is quite straightforward. You fill out a claim form, including 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 thorough. Also, ensure that your physician provides a comprehensive medical report illustrating your disability and its impact on your ability to work. This information plays a critical role in the insurer’s decision-making process.
Aflac Inc. acquired Zurich North America’s group benefits business in 2020, which includes some group disability products. Zurich American Life Insurance Company continues to be the administrator for 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 insurance policies.
The Challenge of Denied Claims
Unfortunately, Zurich does not approve all of the disability claims they receive. Like any insurance company, Zurich American employs a rigorous evaluation process to determine the validity of disability claims. There are a multitude of reasons Zurich may deny a claim. These reasons range from insufficient medical evidence and pre-existing conditions to non-compliance with policy terms.
However, at times, Zurich wrongfully denies valid disability claims. Some claimants meet the definition of “disability” or “total disability” but still receive a claim denial. I’ve seen numerous cases where Zurich American has refused a legitimate claim, leaving the insured party in a challenging situation.
The Definition of Disability
You must meet the definition of disability as defined in your policy 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:
- 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 avenues to challenge 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 appeal process.
As an attorney specializing in this area, I often recommend seeking professional help at this stage. Legal representation can be invaluable in crafting a robust appeal. An attorney can assist you by gathering additional medical evidence and professional opinions and providing the necessary legal arguments.
Working with a Zurich Insurance Company Disability Lawyer
Involving a disability insurance attorney in your appeal process can drastically increase your chances of a successful appeal. As an attorney, I can thoroughly review your policy, the reasons for denial, and your medical records.
My role extends beyond document collection and drafting appeal letters. I am a strategic partner who understands how to navigate the insurance landscape. I can negotiate effectively with the insurer on your behalf. If necessary, I can represent you in court proceedings against the insurer for unjust denial of benefits.
Litigating Against Zurich American Life Insurance
Sometimes, a denied claim may breach the insurance contract’s terms or constitute bad faith practices. A bad faith denial could provide grounds for a lawsuit. Litigation may be viable if your appeal is unsuccessful and you believe Zurich has wrongfully denied your claim.
It’s crucial to understand that this is a significant step. You must have a strong case built on solid evidence to succeed in the United States District Court.
In a lawsuit, we aim to demonstrate that the insurer breached the contract. Zurich must consider claims objectively and in good faith like any other insurer. Demonstrating wrongful denial can mean:
- Showing that Zurich American deliberately misconstrued medical reports.
- Failed to conduct a thorough investigation; or
- Delayed your claim without reason, among other issues.
Claimants may be able to recover benefits due in the form of a lump sum settlement. Claimants may also be eligible for other damages, including attorney fees. If you are unsuccessful in district court, you can appeal the decision to the court of appeals.
Please remember that this information is general, and individual circumstances can vary. If Zurich denies your long-term disability insurance claim, I recommend consulting with an attorney specializing in disability insurance law. This will allow you to discuss the specifics of your disabling conditions and how they prevent you from working. Call Ortiz Law Firm at (888) 321-8131 for advice tailored to your situation.