Disability claim Denial

[tywanda]

I have had liver disease, Hep C, for the last 20 years. I have had two biopsies that show progression (stage 3) and last year quit working because my immune system had started to breakdown and I got an onslaught of infections. I work the public schools as a professional, and now the school's disability insurance company is denying my claim. I was somewhat shocked. Don't insurance companies have some standards, as I was told that my diagnosis (Hep c and depression) would qualify me with Soc. Security, but I am not eligible for that system, as I didn't pay into it while working for the schools.

Any thoughts appreciated.

Judi

 

[beat goes on]

Hi Judi,
Don't give up fighting the4 insurnce company. It took me two years but I ultimatley won. Make sure you keep records of phone cll who with and conversation. Also make sure you keep copies of all correspondence. I ws denied by my compaqn;y ( self insur4ed) after being dx with stage 4 cancer. I finally threatend them with a lawsuit and asked for copies of all correspond4ecne fbetween us. I hd sent in 27 Xrays for an arthritic fcondition ( caused by a fracture to mey heal) along with MRI's and CT Scans ot confrim my illness. They still did not feel I was disabled. They claimed ot have reports form 4 doctors. I asked fo rhte reoports. Tell them you want copies of all doctorws who reviewed your case. If you feel you are beijng harrassed write tothe insruanc3e ocmmmission. However, once I threatend them with a lawsuit they came thru. good Luck. Hope this helps.

 

[ALawyer]

Insurance companies have an absolute duty to honor their policies and pay those claims their policies obligate them to pay. If they act in bad faith, they could be held liable for punitive damages in addition to the benefits they failed to pay.

That said, the terms and conditions and definitions of disability in disability insurance policies vary from company to company, and from policy to policy. Your policy iteslf set forths the definition and standards you must meet and the nature of the proof you must submit to establish disability.

Merely claiming that one can not work and thus is disabled does not do it. Merely stating one has a serious disease does not do it. You must tie the disease or condition into an inability to do the level of work defined in the policy.

This is done by submitting adequate medical evidence -- your treating physician's reports, test results, specialist opinions, etc. While people can do this on their own, and insurance companies pay most claims quickly, in some cases the disability may not be very clear. It may be the evidence of a covered condition or illness is inadequate, or the causal relationship between the illness and the disability is vague, or the tie in between the condition and inability to actually work missing.

In such circumstances lawyers help people establish the disability, by determining what additonal evidence is critical and assisting them in getting it --- benefits may have been denied because the doctor's report was not properly written to demonstrate the nature and extent of the disability and the causative factors, or the onset or likely duration of the disability. Social Security Disability lawyers do this all the time, and so do many insurance lawyers.

An insurance company's staff tends to pay much greater attention when lawyers get involved, as they recognize that the next step may be litigation (which nearly all insurance companies want to avoid) and in some cases, liability for bad faith by way of punitive damage claims.

You may also want to contact your state insurance department and enlist its help, but as most of them are overworked, understaffed and underfunded, it is far less likely to get ytou the results than a lawyer.

Finally, an insurance company is NOT bound by the determination that Social Security would make, nor vice versa.