Chances are that if you’re filing for long-term disability benefits, you know you’re in for a long haul, and possibly a fight (especially if you live in Houston.) Insurance companies would rather not pay you benefits as they’re supposed to, and seem to enjoy making you jump through hoops, dragging out your claim longer than it should take. When they move the hoops again, it may be time to call for help.
Bad Faith LTD Claims
Long-term disability is intended to replace some of your income when you are unable to work while you recuperate from an illness or injury.
When an insurance company denies your benefits, drags out the process or uses other unethical tactics to deny your claim or pay you less than they’re supposed to, it’s called “bad faith.” Rightfully so, because you acquired your policy for the day you need it, and now they’re stalling. Don’t give up when they first deny your claim. That’s the time you’ll need to find an attorney—immediately—who is experienced with ERISA law and bad faith insurance company claims. If you wait, you could miss a deadline, and you could lose your right to appeal. (More information on bad faith LTD is available here on our website.)
Companies use a variety of tactics, including:
- Requiring excessive, duplicate paperwork
- Denying your claim for invalid reasons
- Delaying your claim for an excessive amount of time (possibly causing you to miss a deadline you weren’t informed about)
- Under-paying benefits
Additionally, the Unfair Claim Settlement Practices Act in Texas (Insurance Code Sec. 542.002), states that “an insurer engaging in business in this state may not engage in an unfair claim settlement practice.” Should you discover that your insurance company is engaging in an unfair practice, it’s time to file a complaint.
ERISA
Short for the Employee Retirement Income Security Act of 1974, ERISA is the federal law that governs employee benefit plans. It’s a set of federal guidelines and minimum standards that explain to private employers how to administer employee benefit plans. (Governmental and church-related employers are exempt.)
Insurance companies are in business to make money, not lose it. So any way they can save money by not paying out to policyholders, they will. While ERISA was intended to help employees, it actually ends up having the opposite effect.
Standard Exclusions
There are some claims for which a denial is standard, and is spelled out in every short-term and long-term policy:
- Injuries obtained during the commission of a crime of which you were convicted
- Mental or nervous disorder (some allow these for up to 24 months)
- A normal pregnancy
- Pre-existing conditions
- Alcohol/substance abuse
- War/act of war
- Injuries caused by an aircraft (except scheduled airline passengers)
- Job-related injuries
- Suicide attempts
- Other acts done with the intent to cause disability
There may be others, depending on your policy. Some may be hidden in the fine print; some may even be outright illegal. The wording is deliberately complicated to make filing even more difficult.
Insurance companies have been known to request claimants to fill out forms that ask for purposefully damning information that will help a denial. An attorney who knows and understands disability claims can offer oversight to make sure you don’t accidentally sink your claim.
Be aware that whenever you speak with your insurance company, you’re probably being recorded. If you mention that you are considering hiring an attorney, be prepared for scare tactics or be offered a quick settlement. Don’t accept or sign anything until your attorney has a chance to review it first.
Can You Fight Back?
Yes, you can, even with a denial. But preparation for the fight is the key to winning.
- Start collecting all of your medical records, doctor’s reports and other related documentation. Include evidence of any additional injuries or illnesses that prevent you from working.
- If you’ve already filed a claim and have a denial letter, include that in your file.
- Keep a record of every call and correspondence with your insurance company, including names, phone numbers, emails, dates and times.
If you haven’t filed your LTD claim yet, it may be a good idea to hire an attorney before you file your claim. He or she can guide you through the process and make sure you’ve done all you can for a positive outcome.
Talk To Us First
If you’ve realized your insurance company has participated in bad faith practices, call us immediately. The Herren Law Firm in Houston, TX can assist with your application, appeals and documentation to prove your case and win your claim. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We’ve helped over 4,000 Houstonians get their disability benefits, and we only collect a fee if we win your case.
