ERISA Experience You Can Rely On.

Here’s a wrinkle: One insurer says yes, but another says no

On Behalf of | Jun 23, 2021 | Long Term Disability Claim Denial

Regular readers of this established blog forum know that individuals having disability coverage subject to ERISA regulations and processes frequently confront some claim hurdles and challenges.

And, candidly, they can be formidable.

Blowback can come in an instant case from an insurer’s insistence that a claimant has failed to follow ERISA’s detailed rules relevant to claim filing, proper procedure, appeal and so forth.  Cited causes for delay or denial are many and varied.

The bottom line as underscored by one experienced disability law firm providing strong advocacy on behalf of challenged claimants is this: “Insurers commonly deny or terminate disability claims and appeals.”

The list of exclusionary factors is long and sometimes disingenuous. Insurers routinely contend that applicants’ issues do not qualify as disabilities. Claimants are frequently challenged on grounds that their cited condition is preexisting and thus excluded from consideration. Coverage providers find fault with medical records and documentation. Numerous other grounds also exist for contesting benefit claims.

Here’s something to ponder, though: What if a claimant has multiple disability policies, and one provider approves LTD benefits? Is it the case that another insurer is then obliged to grant benefits as well?

One might logically think so, but that is not an imperative. The above legal source duly notes that “there is generally nothing in disability policies (nor the law) that requires one company to follow another company’s lead in granting benefits.”

A disability claimant might reasonably have questions or concerns regarding benefits and other insurance rights under ERISA. A proven disability law legal team can provide candid guidance and diligent representation in a claim matter.