Las Vegas Disability Insurance Claims Denial Attorney

Going to work is part of life for most folks. Unfortunately, circumstances arise for some that prevent them from gainful employment. When a disability that you were born with or was caused by an injury or illness prevents you from working, disability insurance can step in and provide financial support.

At least, that is the intention.

If you’re attempting to get coverage on a disability insurance policy through a Nevada employer or from the open market, but are being denied, we encourage you to get in touch with a Las Vegas disability insurance claims denial lawyer at your earliest convenience.

The Law Offices of Matthew L. Sharp can provide you with answers you have to questions surrounding your disability claims and your options for appealing a denial.

Types of Disability Insurance

There are several types of disability insurance. These include:

Occupation Disability Insurance

If you’re a professional, you have your own occupation disability insurance. An occupation policy provides benefits if you can’t work or perform your occupation’s material and substantial duties due to a physical injury or illness. The benefits pay until you reach the age of 65.

Another type of disability insurance policy is called any occupation policy. If you cannot work or perform your occupation’s material and substantial duties, the policy provides coverage for a set period, usually 12 to 24 months.

Thereafter, due to a physical injury or illness, if you cannot work in any occupation for which you have education, training, and background, the policy may provide continued coverage.

Overhead Expense Insurance for Small Business Owners

Small business owners may have Overhead Expense Insurance. It covers the business’s operating expenses if the owner cannot work due to a physical injury or illness.

Qualifying for Disability Insurance Benefits

Disability insurance can be purchased individually on the open market or through employment. In Nevada, an employer may offer disability insurance, but the employee can always buy their own disability insurance policy.

To get coverage under your disability insurance policy, you will likely need to show that you’re totally disabled. This generally means proving that you have a sickness, illness, or injury that prevents you from doing the material duties of your job. The definition of total disability will depend upon the terms of your insurance policy.

Your policy may also have coverage for residual disability, which generally means your sickness, illness, or injury has caused a loss of earnings of 20 percent or more.

Group disability insurance policies may limit coverage to non-work-related injuries. The sickness, illness, or injury generally involves a chronic problem that will not improve over time.

Disability Insurance vs. Workers’ Compensation

Disability insurance may provide a set monthly amount or a percentage of your salary. However, disability insurance is different from workers’ compensation, which only applies when you have a work-related injury that prevents you from performing the material duties of your occupation.

The amount you will receive while on short-term disability will depend on your policy.

Reasons Disability Claims Can Be Denied

An insurance company owes you a duty of good faith and fair dealing. This means the insurance company must consider your interest at least equal to its own and investigate your claim fairly to support the payment of benefits. When they don’t, that is known as bad faith insurance.

Unfortunately, insurance companies commonly prioritize profits over policyholders. They may employ unfair tactics to deny or delay processing a legitimate claim. Some common reasons short-term disability claims are denied include:

• Claiming the insured is not disabled from their occupation
• Citing inconsistencies in medical or employment records
• Alleging lack of medical evidence to support a disabling condition
• Claiming the insured made material misrepresentations

Your insurance company may even contact your doctor. Your doctor must understand the attending physician’s statement and your limitations to avoid any misinterpretation by the insurance company.

How to Challenge a Short-Term Disability Claim Denial

Your insurance company has a duty to assist you during a claim. You should never hesitate to ask your insurance company about policy provisions and the status of your claim.

Your appeal process should be outlined in your insurance policy or disclosed in the claim denial letter. When filing an appeal, you are entitled to obtain all relevant claim information from your insurance company.

Meeting Appeal Deadlines

The deadline for appealing is usually 60 to 120 days. Missing this deadline could prevent you from challenging the denial decision.

Determining the Reason for Claim Denial

The insurer must disclose the basis for the denial, including the specific policy provisions relied upon. You should obtain a copy of your insurance policy and review it carefully. While you can file a formal complaint with the Nevada Department of Insurance, your next step might be to take legal action.

Seeking Legal Support

A Las Vegas disability insurance claims denial lawyer will review your original claim and policy documents to determine whether the denial was justified. Legal representation can:

• Identify additional documentation necessary to strengthen your claim
• Recommend medical evaluations or functional capacity assessments
• Ensure your medical records and doctor’s reports accurately reflect your disabling condition
• Challenge the evidence presented by your insurer

If your appeal is denied, your disability lawyer can take your case to court, presenting expert witnesses and evidence to support your claim.

How To Strengthen Your Disability Claim

Filing a disability claim can be frustrating, especially when you’re already dealing with health challenges. But there are things you can do to improve your chances of approval.

• Get strong medical evidence: Your medical records are the foundation of your claim. Make sure your doctor documents your condition, including test results, treatment plans, and how your symptoms limit your ability to work. If something is not in writing, the insurance company may argue it doesn’t exist.
• Talk to your doctor: A supportive doctor can be a game-changer. Have an open conversation about your disability and how it affects your daily life. Ask them to provide a detailed statement that clearly explains why you’re unable to work.
• Keep a symptom journal: Sometimes, it can be easy to forget how often symptoms flare up or how they impact you. Writing down daily struggles, like pain levels, fatigue, or mobility issues, can provide solid evidence to support your claim.
• Stay organized: You will want to keep track of every appointment, test, prescription, and communication with your insurance company. If you’re denied, having detailed records will make appealing much easier.

The more evidence you have, the harder it is for the insurance company to deny your claim.

When Should You Hire a Las Vegas Disability Insurance Claims Denial Lawyer?

The best time to hire a lawyer for your disability case is as soon as you suffer a disabling condition that prevents you from working. A lawyer can help:

• Guide you through the claims process
• Protect your rights and interests
• Increase the likelihood of claim approval

Most disability lawyers work on a contingency fee basis, meaning you only pay legal fees if you win your case. Be sure to review and understand the terms of your lawyer’s contingency fee structure before proceeding.

If you’re dealing with a denial, the Law Office of Matthew L. Sharp is ready to help.

Contact us today to schedule a consultation with our Las Vegas disability insurance claims denial lawyer.