{"id":1785,"date":"2021-08-23T19:55:49","date_gmt":"2021-08-24T00:55:49","guid":{"rendered":"https:\/\/nolfinal.wpengine.com\/?page_id=1785"},"modified":"2023-10-11T13:40:59","modified_gmt":"2023-10-11T18:40:59","slug":"principal","status":"publish","type":"page","link":"https:\/\/www.nickortizlaw.com\/insurance-companies\/principal\/","title":{"rendered":"Principal Disability Insurance Denials"},"content":{"rendered":"
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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<\/a>. 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<\/a>.<\/p>\n\n\n\n

Reasons for Principal Disability Insurance Denials<\/h2>\n\n\n\n

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 why the claim was denied. Below, we discuss some of the most common reasons disability insurance claims are denied:<\/p>\n\n\n\n

Non-Medical Requirements<\/h3>\n\n\n\n

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, like working a specific number of hours each week before 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 United States federal courts). If you do not meet the non-medical requirements in your disability insurance policy, Principal Financial will deny your disability claim.<\/p>\n\n\n\n

Medical Requirements<\/h3>\n\n\n\n

Principal Financial disability insurance policies also have specific medical requirements<\/a> that a claimant must meet 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\u2019s Statements (APS)<\/a>, and home visits or field interviews conducted by the insurance company<\/a>. Failure to provide the necessary medical records and documents to support your insurance claim will result in claim denial.<\/p>\n\n\n\n

Medical Reviews and Independent Medical Examinations<\/h3>\n\n\n\n

In some cases, Principal Financial may conduct a more in-depth investigation of a disability claim. It is not uncommon for the insurance company to order a consultation with a vocational expert<\/a> or a medical review of your file<\/a> by the Principal’s medical director. Your claim may be denied if they determine the evidence does not support your reported symptoms and limitations.<\/p>\n\n\n\n

Principal Financial Group may also have you attend an “independent” medical examination<\/a> 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. We believe a compulsory medical examination would be a more accurate name for this part of a disability claim.<\/p>\n\n\n\n

Video Surveillance<\/strong><\/h3>\n\n\n\n

Insurance companies such as Principal Financial are also known to conduct surveillance<\/a> 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.<\/p>\n\n\n\n

Social Media Surveillance<\/h3>\n\n\n\n

Another common surveillance tactic in disability claims is reviewing the claimant’s social media accounts<\/a>. 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.<\/p>\n\n\n\n

The frequency of an insurance company’s verification of a claimant\u2019s current disability status depends on the controlling policy\u2019s definition of \u201cdisability,” the claimant\u2019s medical condition(s), and the prognosis of the claimant\u2019s medical condition(s). Most insurance companies, including Principal Financial, will contact claimants\u00a0at least once every 18-24 months to verify their condition has not changed.<\/p>\n\n\n\n

Appealing a Denied Principal Financial Disability Claim<\/h2>\n\n\n\n

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 you must 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.<\/p>\n\n\n\n

Do I Have to File an Appeal?<\/h3>\n\n\n\n

If you have a group Principal insurance policy through your employer, your claim is likely governed by the Employee Retirement Income Security Act (ERISA)<\/a>. 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 appeal process.<\/p>\n\n\n\n

Hire a Principal Financial Group Disability Attorney<\/h2>\n\n\n\n

Our team will usually receive a call from a claimant after receiving 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.<\/p>\n\n\n\n

How Ortiz Law Firm Can Help with Your Claim Denial<\/h3>\n\n\n\n

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:<\/p>\n\n\n\n