Why Valid Insurance Disability Claims Get Denied and How You Can Avoid It

Disability Claims Lawyer Los Angeles

Sometimes, even if your disability is genuine, your disability claim may still be denied by your insurance company. It should not come as a surprise.  Insurance companies are not there to help prove your disability even if it’s evident—the burden of proof rests on your shoulders. Specifically, it is dependent on the completeness and strength of the medical evidence you can present.

There are practical steps you can take to avoid getting denied. Whether filing for short- or long-term disability, hiring a disability attorney in Los Angeles will be helpful, to make sure all the bases are covered.

If you feel confident enough to file the claim on your own, make sure you understand your rights in the State of California and your responsibility to present sufficient evidence for your case. Also, be aware that some insurance companies may hire someone to gather evidence that disproves your claims.

Know Your Rights in Los Angeles, CA. Beware of Discretionary Clauses

Beware of disability insurance policies slanted in favor of insurance companies, especially due to discretionary clauses. Discretionary clauses are provisions in an insurance policy or plan that can only be interpreted by the plan administrator or provider.  Although they’re no longer allowed in California, some insurers may think they can still get away with the old system.

The problem with discretionary clauses is obvious. Only the insurer or plan provider can determine who is eligible to receive benefits as a result of the clause or resolve questions concerning it.

Since 2012, the California Insurance Code section 10110.6, which says that grants with discretionary clauses can be made void and unenforceable, have protected California residents from this shady practice. As an insured employee or disability insurance policyholder, you should know that you can contest such provisions should you find them in your insurance policy.

Be Proactive in Submitting Medical Proof

Make sure that you submit the required medical documents on time. Note that some insurers may “fail” to get your medical records on purpose.

Your insurer should give you a list of medical records for submission. If they don’t, ask for it. Make sure you’re not missing anything out. Get receiving copies signed. Once you’ve submitted all required documents, verify with them that they have received every document you sent them.

You should also get a written statement from your doctor or doctors and make sure it’s clear on the severity of your situation and the length of time it takes to recover from it if it’s not permanent.

Be proactive. Most long-term disability cases will be denied due to a lack of medical proof. Telling the truth is not enough. You have to prove that you are telling the truth.

Prevent Counter-Evidence. Be mindful That You’re Under Investigation

Your insurance company may hire an investigator to gather evidence to disprove your disability claims. Evidence can be in the form of surveillance videos, social media posts, proofs of your activities, and even non-appearance to medical appointments.

It is possible to find evidence that misrepresents your true condition. Let’s say your doctor diagnosed you with fibromyalgia. Your particular state will make you unable to work on bad days, but may allow for some good days. Your employer may also advise you not to work during some good days to manage your condition.

If, during a non-working good day, an investigator took a video of you carrying your garbage out or raking leaves on your lawn, your insurer may use the video against you. It wouldn’t be an accurate representation of your condition, but the video will be hard to refute.

You may contest by presenting your doctor’s statement, but what if it’s too late to submit one? And what if your doctor says he doesn’t allow you to engage in such activities? You can’t predict how creative and imaginative people can get when coming up with evidence to contest claims, so it’s best to lie low during an investigation.

Moreover, you have to follow medical treatment and doctor’s orders faithfully. Failure to attend doctor’s appointments and follow treatment procedures may be used as evidence of the absence of your condition.

Don’t Settle

Aside from the above challenges, your insurer may also delay or slow down the filing and investigation process. And after a lengthy battle, they may offer you less than the amount you think you deserve. When this happens, you have every right to appeal your claim immediately or within 180 days, with the help of an attorney.

At Haffner Law in Los Angeles, our disability attorneys are experienced and aggressive in dealing with bad faith insurance. We will walk you through the appeals process and build you a solid case that will help you get the benefits you deserve.

For a free, no-obligation consultation, contact us at 1-844-HAFFNER (213-514-5681).

 

Not Having Disability Insurance: The Financial Risks

Disability Insurance Lawyer Los Angeles

While some people are lucky enough to live their lives without ever having to fall back on their insurance, most Americans file claims for something or other. Some of the most common policies that are claimed are health insurance, car insurance, and homeowner’s insurance. These policies are helpful in a variety of ways, but mostly for the payment of some kind of loss.

In spite of this, about 13.7 percent of Americans are uninsured. If people do not apply for something as basic as health coverage, it’s no wonder there are a lot of other types of insurance that get overlooked. Unfortunately, it’s not until a person is in the wrong place at the wrong time that they realize how much insurance policies help.

Take for example disability insurance. According to the Journal of the American Society of Certified Life Underwriters, women are three times more likely to be disabled at work for more than 90 days than their male counterparts. Yet, 52 percent of single female workers in the U.S. do not have disability coverage. Of those who are insured against disability, only 55 percent said they have enough coverage.

Why More Than Half of Single Female Workers Don’t Have Disability Insurance

There are two basic kinds of disability insurance policies: one for short-term disabilities and the other is for long-term disabilities. The former can provide financial coverage for about three to six months, although under California laws, short-term disability insurance policies can last up to a year. Meanwhile, if you become disabled for more than six months, you may qualify for long-term coverage.

Unfortunately, companies aren’t required to offer long-term disability insurance, which, taking the probability of disability among women in the workplace, means one in three women are “extremely unprepared” for any length of disability if they lose their income because they cannot work.

This figure is from the most recent findings of The Council for Disability Awareness (CDA). The CDA added that over half of the women without disability insurance said they didn’t even know enough about it.

Apart from those reasons, women may not have disability insurance because the requirements to qualify are rigorous. What’s more, the benefits of having long-term disability coverage can take months, if not years, to kick in. This means you must have an emergency fund or other financial sources for the period you can’t work, especially if your disability prevents you from doing so for a while.

In addition, some insurance providers do their best to deny you of your rightful coverage, especially for long-term disability insurance, in which case you should consult disability insurance lawyers in Los Angeles. Because of the stringent qualifications, even the smallest paperwork issues can prevent you from filing for a claim.

Turn to Trusted Disability Lawyers in Los Angeles

Insurance companies will be less likely to deny you of your claims or take advantage of your lack of sufficient knowledge about the ins and outs of disability coverage if you have legal representation. You can get that in Los Angeles from Haffner Law.

We understand how challenging it can be to file for a disability insurance claim. That is why our lawyers walk you through the process to help you get the benefits you’re entitled to.

For a free consultation, contact us at 1-844-HAFFNER (213-514-5681).

 

Insurance Policies For Self-Employed Individuals

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As a self-employed individual, you are your own business. And in the same manner that a traditional organization compensates its members for their work in terms of wages and benefits, you will likewise ensure that you, and any individual in your employ, receive proper remuneration.

Foremost to this is an appropriate insurance policy. Accidents and untoward incidents can happen at any given time to you, your employees, or your place of work, and as the person in charge, it is only prudent that you protect your assets. For the self-employed individual, below are the three primary types of insurance you should get.

Health Insurance

American law mandates that its citizens have access to basic health insurance, and penalizes individuals who do not acquire one. Employees who work for a company will generally have a health insurance subsidized by their employers, but the self-employed, unemployed, or underemployed will have to get their own policy.

For the self-employed worker, a high deductible health plan (HDHP) is an excellent choice for insurance policy because of its affordable but wide-ranged structure. Under the HDHP, individuals will initially have a higher upfront cost of health services before the insurance plan formally takes effect, but will eventually enjoy lower monthly premiums, and easier access to a wide range of medical services. In such case, it is prudent to have an emergency fund in place to mitigate the initial expenses. If you have not yet started an emergency fund for you and your dependents, it is highly recommended that you open one immediately.

Disability Insurance

For the self-employed, no work means no pay, and such a system could prove debilitating in the unfortunate event of an injury, sickness, or similar incapacitating circumstances. Protect yourself and your loved ones from such situation by getting a top-quality disability insurance plan.

This type of insurance comes in two forms: a short-term policy, and a long-term plan. The former covers a brief period of time, for a specific number of reasons, which can include a three-to-six month compensation for an individual involved in a minor accident but is expected to fully recover, a period of maternity leave for a mother who just gave birth, and other similar cases where the insured is unable to return to work only for a short, specific period of time.

On the other hand, long-term disability insurance plans have less-rigid terms, and are designed to protect its holders in worst-case scenarios, where the disability, defined as the general failure to earn a living, can last longer, or even permanently. Common examples would be a grievous injury, whether incurred at work or elsewhere, crippling sickness, or other debilitating personal circumstances. In such case, a long-term insurance plan will ensure that your basic needs, especially medical and rehabilitation expenses, will still be met, and your beneficiaries will not suffer because of your inability to provide for them.

It is important to note that because disabilities vary on a case-by-case basis, insurance companies will have strict policies and requirements as to who qualifies for compensation. In places like California where health care policies are continuously evolving and becoming more nuanced, it is your responsibility to exercise due diligence and thoroughly research your local and state policies. Get in touch with your provider, or have a consultation with legal professionals to learn more about this. L.A. residents in particular can contact our Los Angeles disability insurance lawyers to have a better understanding of Californian insurance policies, as well as to assist with claims should the need arise.

Business Insurance

Lastly, you must likewise secure your actual livelihood against risks inherent to the industry. There are four main types of business insurance necessary for the self-employed.

General Liability Insurance

This form of business insurance covers generally physical incidents that are taken to court. Examples of such would be a customer injured in your establishment, or a client’s property damaged because of your direct or indirect actions. This is especially important for self-employed workers who handle physical products and services, like repairs, transportation, warehousing, etc.

Professional Liability Insurance

This second type covers untoward incidents directly related to or as a consequence of your work, primarily of the financial nature. For example, a developer who mistakenly codes a faulty software that ended up costing his client money in operations losses will be protected by this form of insurance, provided that it is proven the damage is entirely accidental.

Business Owner’s Policy (BOP)

Similar to the previous insurance type, the BOP has a wider and more generic range of coverage, which can include financial liabilities, property damage, and other similar incidents within your place of work. Because of its more generic nature, BOP is also generally a cheaper alternative to the professional liability insurance.

Worker’s Compensation

A mandatory insurance policy that any employer must have, this business insurance must be one of the first policies you acquire when you begin to hire people for your company. This is a protection for your employees, generally covering a loss of income as a direct result of incidents at work, which may include lost wages and medical expenses.

As a self-employed individual, you are responsible for your own compensation, as well as the remuneration of any who might work under you. Protect yourself, your stakeholders, and your business with the right insurance policies. Secure your health insurance, disability insurance, and business insurance now.

Sneaky Surveillance Tactics Insurers May Use to Deny Long-Term Disability Benefits

Disability Insurance Lawyer Los Angeles

Long-term disability insurance firms spend a lot of money yearly to spy on their claimants. On top of performing surveillance, insurers want to “catch” individuals doing activities that are not consistent with their disability claim. If the insurance company is successful, it will use the evidence to deny the claimant’s long-term disability benefits, saving money.

How far will your insurer go to spy on you? Insurance companies are willing to use these tactics:

Background Checks

An insurance firm hires a third-party investigator to perform a comprehensive background check on you. The report from the in-depth screening can include the following information:

  • Your physical address
  • The people living with you (e.g. parents, children, significant other, etc.)
  • The kind of vehicle you drive
  • Criminal history, including driving offenses
  • Active permits and licenses
  • Business registered in your name (or your partner’s name)
  • Properties registered under your name

The investigator uses the information from the report as a starting point for further surveillance.

Photo and Video Surveillance

Investigators usually park outside your house for a couple of days and use a small camera. They sit in their vehicle for hours and wait to pick up activity on their recording device. If you leave your house, the investigator may secretly follow you and continue to record your movements once you have reached your destination.

When it comes to photographic or video surveillance, investigators want to find out whether you leave your house, what you do when you go out, and how frequently you leave your home. They also take note of the following minor details:

  • How you dress (e.g. in sneakers or high heels)
  • Any items you carry, including a bottle of water and a handbag
  • Any assistive devices you’re using, such as a wrist brace or a cane

When investigators capture small but useful snippets of activity, the insurance firm uses them as evidence to deny your claim.

Social Media Checks

Accessing social media accounts is generally a simple and affordable way for insurers to gather personal details about their claimants. Many profiles contain vast amounts of information that the insurance company can use to draw conclusions.

Investigators usually search for your name in any of these popular social media sites:

  • Facebook
  • Twitter
  • Instagram
  • LinkedIn

When investigators perform searches, they look at your activity and note down the following details:

  • Comments on interactions and posts with other users
  • Photos and what you’re doing in those photographs (e.g. pictures of recent vacations)
  • Status updates
  • Location
  • Relationship status
  • Hobbies
  • Employment status
  • Profile picture

General Web Searches

Insurers also perform general internet searches to find any information that’s inconsistent with your long-term disability claim. They may search the web for the following:

  • Articles about you
  • Photos of you
  • Comments you post on blogs or other sites
  • Personal and business web pages

Individuals who received a notice of denial from their insurer can seek the help of Haffner Law. Our experienced disability insurance lawyers in Los Angeles guide clients through the appeals process and help them get the benefits they need.

Contact us today for a free, no-obligation consultation.

Long-Term Disability Insurance Appeal: Your Next Step After a Denial

Disability Insurance Lawyer in Los Angeles

Long-term disability (LTD) insurance is a beacon of hope for injured people struggling in the aftermath of an accident. If your disability continues longer than six months, your LTD insurance will cover your needs as long as your disability lasts. For this reason, it’s best to immediately file for a claim application to receive benefits as soon as possible.

But what do you do if your claim gets denied?

Why LTD Applications Get Denied

The Employee Retirement Income Security Act (ERISA) is a federal law that governs all established health and pension plans in private organizations, which include employer-provided long-term disability policies. As per ERISA, claim administrators who work for the insurance company are in charge of evaluating the claims. Due to the inherent conflict of interest, claim adjusters deny deserving claims even if there is clear evidence of disability.

There are different reasons behind an adjuster’s denial. Some of the most common include the following:

  • Insufficient medical evidence
  • Video surveillance inconsistent with allegations of disability
  • Failure to meet the policy’s definition of disability
  • Missed deadlines

If an adjuster denies your claim, don’t lose hope. Some insurance companies initially deny claims, regardless of their merit. With persistence, patience, and the help of experienced disability insurance lawyers in Los Angeles, you can still appeal for your insurance claim. However, there can be strict and short time limitations for appealing a denial of disability benefits, so you must determine the deadline and act quickly to submit your appeal.

Appealing Your Denial: The First Steps

Get a copy of the policy. Obtain a copy of your long-term disability policy documents, which should also include the summary plan description. You can get it directly from the insurer or from your company’s human resources department (for businesses that provide group insurance). If both parties fail to provide these documents, you can request them from the insurance company’s plan administrator.

Study your denial letter. With your disability attorney, review the denial letter sent by the insurance company. Take note of the reasons behind the claim’s rejection and gather other information to support your claim’s approval. Don’t forget to mark deadlines on your calendar, too.

Strengthen Your Case with Favorable Evidence

Track down missing records. In some cases, plan administrators and insurers fail to obtain all the medical records relevant to your claim. Strengthen your appeal by finding out which records were used to decide your case. If anything is missing, let your claims administrator know and determine the date when they received and requested all the records.

Find out if medical tests would help. Most insurance companies cite the lack of medical evidence as a basis for denying your claim. Get in touch with your claim administrator and ask if medical testing, such as blood tests, MRIs, or x-rays, would help your case.

Seek your doctor for a written opinion. Ask your doctors to provide a written opinion that lists down work-related limitations caused by your injury. A disability insurance lawyer can help you craft specific questions to ask your physicians.

When you’re injured or unable to work, disability insurance can help you get back on your feet as soon as possible. Reap the benefits of your insurance by avoiding claim denial or appealing for it with the help of a trusted disability insurance attorney.

Haffner Law’s team of lawyers are eager to assist. Get in touch with us today and let us fight for your rights.