Claims for disability benefits involve pulling together the necessary documentation and support for an internal, administrative appeal of the insurance company’s denial of benefits. Thorough review of the actual disability benefits policy and employee manual is essential.
Mari Bush and Bruce Kaye often meet with the pertinent health care providers (doctors, physical therapists and others) to obtain additional reports or affidavits to support the appeal, consistent with the terms of the disability policy. In addition, it may also be advisable to review the job description, speak with colleagues about the actual duties of the client’s work and retain the services of a vocational expert. These latter steps may be needed in order to show how a client’s disabilities compare to the language in the policy and the essential duties of the client’s position.
Most claims for the wrongful denial of disability benefits fall under a federal statute known as ERISA. If so, then separate procedures and legal remedies apply. However, there are exceptions to ERISA-covered disability plans (such as for government employees), so it is important to make sure these claims are postured correctly. Non-ERISA claims offer more legal remedies. ERISA issues in a wrongful denial of disability insurance matter are complex and must be analyzed carefully.
With the client’s permission, Kaye and Bush, LLC oversees their approved claims on an ongoing basis. The purpose of this ongoing oversight is to make sure the appropriate documentation (including periodic statements from a treating physician) is supplied to the insurance carrier in a timely fashion.
Kaye and Bush, LLC welcomes the opportunity to help clients navigate the challenges of receiving their initial benefits, reversing any appeals and assisting in the long-term continuance of the disability benefits.