New Reasons for Denying Disability Benefits Not Permitted
Under the law of the Employee Retirement Income Security Act or ERISA, a disability insurance company is required to give the claimant adequate notice of its reason(s) for denying long-term disability benefits and an opportunity for the claimant to respond. ERISA also requires disability insurance companies to give a full and fair review of denied disability claims. That means that the insurance company must review all the evidence provided and conduct a thorough, unbiased review of your disability claim. Together, this means that the insurance company cannot deny a disability appeal based on a new reason, one that is different from the reason given in the original denial.
Under ERISA, the claimant must be given adequate notice as to the insurance company’s decisions and reason(s) for such decisions. And then the claimant must be given a chance to respond to each reason given. If the insurance company fails to do this, it is in violation of the law.
For example, suppose you file a long-term disability claim and the insurance company initially denies your disability claim by claiming you have a pre-existing condition that is not covered under your disability insurance policy. You then file your appeal to have your file reviewed. With your disability appeal, you provide clear documentation that you do not have a pre-existing medical condition.
When the insurance company reviews your claim on appeal, they again deny your benefits, but this time they indicate that you do not have enough medical evidence to prove that you are disabled. This action by the insurance company of switching reasons why it is denying your disability insurance benefits is a violation of ERISA.
You have rights under ERISA and deserve a full and fair review of your disability claim. An experienced ERISA disability attorney can spot the tactics of the insurance companies and take the necessary steps to ensure your disability claim and appeal is lawfully and fairly evaluated as ERISA requires. Our law firm is familiar with the tactics disability insurance companies use to deny people disability insurance benefits they deserve. Call us to speak with one of our disability insurance attorneys to hear how we can help.