| It is a common scenario that insurance companies | | | | disputes. However, if you wish to proceed on |
| who have sold you a disability policy attempt to | | | | your own, you should familiarize yourself with all |
| terminate benefits claiming the disability is no | | | | three elements of the letter above and |
| longer present, or severe enough to prevent | | | | adequately educate yourself to understand the |
| employment. This most commonly occurs | | | | contract language, the applicable law, the time, |
| between two to four years after receiving the | | | | method and process for appeal, as well as the |
| benefits depending on the type of language in | | | | contested fact issues. |
| your contract. Most disability insurance policies | | | | To contest the insurance company's decision, you |
| include a time period ranging from two to four | | | | should immediately gather medical evidence to |
| years after which the definition of total disability | | | | support your position that you are disabled. This |
| changes. The definition typically narrows which is | | | | information will come from your medical records |
| generally bad for the policy holder. This change | | | | and even more appropriately you're treating |
| may take the form of either increasing the | | | | physicians. You should contact each of your |
| number of occupations which should be considered | | | | treating physicians and provide them with a copy |
| before determining if you are disabled, or | | | | of the insurance company's termination letter. Ask |
| narrowing the requirements to meet ongoing | | | | your physicians, if they still believe that you are |
| disability. | | | | disabled, to write letters explaining in detail the |
| Furthermore, disability policies include the right of | | | | medical reasons which lead them to conclude that |
| the insurance company to obtain your medical | | | | you are disabled. The doctor should also include |
| records, and to periodically have you examined | | | | their opinion that you continue to be disabled in |
| for the purposes of determining if you are still | | | | their letter. |
| disabled. | | | | You should also write the company and ask them |
| If you and your physicians know that you are still | | | | to provide you a copy of your claim file, as well |
| unable to work, then a swift and thorough | | | | as any documentary evidence they have |
| response must be made when an insurance | | | | supporting the facts that they have relied upon in |
| company notifies you of their intent to limit or | | | | making their decision. |
| terminate your benefits under the disability policy. | | | | In doing this, you should be aware that insurance |
| Typically speaking the insurer will notify you in | | | | companies are subject to laws that have been |
| writing and provide you with its reasons for the | | | | adopted in each of the 50 states in the United |
| elimination or termination of your benefits. This | | | | States regarding fair claims practices. Most State |
| letter also includes important information | | | | Departments of Insurance have adopted specific |
| concerning how to fight the insurance company's | | | | regulations on how to implement these fair |
| decision. First, the letter should give you the | | | | practice claim acts. For instance, most states |
| necessary directions on how to contest the | | | | have specific requirements about time period in |
| decision. Most disability policies have provisions | | | | which an insurance company should respond, and |
| requiring an appeals process before suit can be | | | | specific types of information they must provide |
| filed. Whether or not these particular appeals must | | | | to you. In addition, the common law has |
| be followed is a legal question that can only be | | | | developed legal rules that apply to insurance |
| determined after it is known which laws are | | | | companies. |
| applicable to your particular insurance contract. | | | | You should properly prepare your appeal and |
| However, it is generally advisable to follow the | | | | supply all necessary documentation to the insurer |
| appeals process as it is your first opportunity to | | | | prior to the stated deadlines. |
| have the decision reversed. The letters should | | | | Your letter should include a statement indicating |
| also advise you of the policy terms, conditions or | | | | that you disagree with the decision of the |
| exclusions which the insurance company identifies | | | | insurance company as well as your reasons for |
| as part of the agreement entitling them to | | | | the appeal. This would be based upon the medical |
| terminate or eliminate your benefits. | | | | records and evidence you have obtained from |
| Notably, insurance companies do not always | | | | your doctors, as well as the appropriate contract |
| interpret these provisions correctly and therefore | | | | language, and applicable law. |
| they need to be reviewed closely to determine if | | | | You may also wish to contact your state |
| the insurance company is relying on the proper | | | | department of insurance and file a complaint. If |
| language, omitting relevant language, or | | | | you do so, you may wish to include a copy of |
| misinterpreting the language. Finally, the letter will | | | | the complaint with your appeal. |
| also list the specific reasons the insurance | | | | Undertaking an appeal of a denial of benefits |
| company claims that you do not meet the criteria | | | | requires knowledge, skill and determination. If you |
| for disability. This information constitutes the facts | | | | are unable to take up this challenge yourself, then |
| that the insurance company is relying upon to | | | | you should contact an experienced insurance |
| make their determination and should be a primary | | | | claims dispute attorney to assist you with your |
| focus of your attack. | | | | appeal, and if the appeal is denied to properly file |
| If you have received such a notice of termination | | | | suit on your behalf so that you can receive the |
| or termination letter from your insurance | | | | benefits of the insurance policy which you bought |
| company, it would be prudent for you to seek | | | | and paid for. |
| knowledgeable attorneys in insurance claims | | | | |