Insurance Company Refusal to Pay Disability

If you’ve been disabled and can’t work, if you have a disability insurance policy through your job, that policy is supposed to take care of you. Unfortunately, all too often it doesn’t, because the insurance company doesn’t want to pay. However, you’re not required to simply accept the insurer’s determination—you can assert your rights.

Common Ways It Can Happen

Generally speaking, there are two grounds under which insurers will refuse to pay:

• The most common reason is that they don’t believe—or at least won’t admit—you’re disabled. This could be a legitimate, good faith difference of opinion, but often it’s not. Many insurers reflexively challenge almost every disability claim, especially if the disability is one that is not necessarily immediately obvious and clearly incontrovertible.
• Also, if there are any paperwork irregularities, the insurer may seize on that as grounds to delay or deny payment. Often, this will be based on any errors or omissions—even trivial ones—in how your claim was submitted, or the medical documentation backing it up.
• Sometimes insurers may also try to challenge your original enrollment in the disability policy, such as the information provided about you. If they can show your enrollment was improper in some way, they can avoid paying.

Insurers don’t want to pay—the more they pay out, the less money they make. By challenging your claim, they can avoid, or at least delay, having to make good on their obligations. It is in their interest to challenge your claim—just as it is in your interest to challenge their refusal to pay.  

Filing a Complaint

The Employee Retirement Income Security Act (ERISA) is a federal law which governs a number of different kinds of employee benefits. It’s most commonly associated with retirement or pension plans, but it applies to disability insurance, too. Therefore, if you’re considering  bad faith claims (or any kind of claim) against your insurer, what you’re really considering is a ERISA claim. What that means is that you have to comply with the requirements of ERISA, which can be very technical—and which are in many ways slanted in favor of your employer and its insurer. That doesn’t mean that filing ERISA claims is waste of time—just that they are even more challenging in many ways than most legal claims or lawsuits.

When to Talk to a Disability Lawyer

To win an ERISA claim, you need to show that your insurer improperly denied you benefits. This involves not just proving the existence of a serious medical condition and that you can’t work, but also proving bad faith on the insurer’s part. Doing this, while complying with ERISA’s (and your disability insurance policy’s) requirements is not something for “on the job training”—you need an experienced attorney, one who knows the rules and knows how to make the case, representing and advocating for you.

It’s no exaggeration to say that having a good attorney is often the difference between receiving the compensation you’re legally entitled to—and which you deserve—and not. An attorney can make your claim for you, while you concentrate on your health and any changes or adjustments you need to make to your life.