Las Vegas Disability Insurance Claims Denial Lawyer
Disability insurance protects you in the event that you cannot work. If you’re in a situation where 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 do not help with social security claims, however), we encourage you to get in touch with a Las Vegas disability insurance claims denial lawyer at your earliest convenience.
There are different types of disability insurance. If you are a professional, you have an own occupation disability insurance. An own occupation policy provides benefit in the event you cannot work or perform the material and substantial duties of your occupation 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 the material and substantial duties of your occupation, the policy provides coverage for a set period of time usually 12 to 24 months. Thereafter due to a physical injury or illness and if you cannot work in any occupation for which you have education, training, and background due to the same physical injury or illness.
Small business owners have may disability insurance called Overhead Expense Insurance. It covers the operating expenses of the business in the event the owner is unable to work due to a physical injury or illness.
Disability insurance can be purchased individually on the open market or it may be available to purchase through your 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 are totally disabled. This generally means you will have to show you have a sickness, illness, or injury that prevents you from doing the material duties of your job. The definition of totally disability will depend upon the terms of your insurance policy. Your policy may also have coverage for a residual disability which generally means your sickness, illness, or injury has caused of 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 may provide a set amount each month or it may cover a percentage of your salary. Regardless, you will need to document that you cannot work in your occupation because of a sickness, illness, or injury.
Disability insurance is different than workers compensation insurance because workers compensation applies only 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 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 interest, and it must investigate your claim to look for reasons to support the payment of the claim.
Unfortunately, insurance companies commonly prioritize generating profits over their insured clients’ interest in obtaining insurance benefits. Your insurance company may employ unfair tactics to deny or delay processing a legitimate claim valid claim. You should not let the insurance company tactics lead you to abandon a legitimate claim. The following are common reasons short-term disability can be denied:
Insurance companies often claim that an insured is not disabled from their occupation or job. They may claim there are inconsistencies in the medical records or employment records. They may cite a lack of consistency in the insured’s or claimant’s conduct. The insurance companies may even claim the insured or claimant made material misrepresentations. The common reasons for denying a claim are: (1) the insured is not totally disabled under the terms of the policy; and (2) the absence of medical evidence to support a disabling condition.
Your insurance company may even call your doctor. It is important for the doctor to know that the insurance company may have a hidden agenda to take your doctor’s comments out of context to try and deny the claim.
If you have received a denial of what despite having a qualifying disabling condition, you should know the reasons a disability claim can be legally denied. Any one disability claim is unique and the factual basis for denial will vary from claim to claim. The reasons for denial vary from one claim to another. Fortunately, you have a legal right to contest the denial of a disability insurance claim by appeal or a denial of disability insurance claim. A knowledgeable Las Vegas disability lawyer can help you prepare and file a strong appeal to increase the likelihood of your short-term disability benefits getting approved.
A Conclusion that You Are Not Disabled
An insurance company may claim there is insufficient medical evidence to show you are totally disabled. You should make sure and thoroughly review your statement of disability (this is a form for your insurance company). You should work closely with your treating physician to make sure they understand attending physician statement (this is a form your treating physician will complete) and make sure they understand your limitations. Doctors are very busy, and they may ask nurses to complete the form. It is important for the doctor to review what is being sent to the insurance company.
Understanding your medical records and your medical condition and working with your doctor is important in presenting your claim.
A disability lawyer can examine the terms of your policy to determine if you have a qualifying injury, sickness, or symptom. The lawyer can ensure your medical records and doctor’s report accurately describes your disabling condition. This strategy helps you stand a better chance of securing approval.
A lawyer who is experienced in handling these types of cases can help victims recover fair settlement amounts.
Can You Challenge a Short-Term Disability Claim Denial?
Yes, you may have the right to appeal claims denial and you have the right to file a court action. It is very important to contact and hire a lawyer once the claim is denied. You should never wait until all appeals have been exhausted.
Familiarize Yourself with the Claims Process
Your insurance company has duty to assist you during a claim. You should never be afraid to ask your insurance company about policy provisions and the status of their investigation. Your insurance company should be telling you what you need to do to show that your claim is covered.
Your appeal process should be in your insurance policy or disclosed in the claim denial. When you file an appeal, you should able to get all the information from your insurance company regarding your claim so you can file an appropriate appeal if you so desire.
The deadline for appealing is usually 60 to 120 days. Missing the deadline for appealing could later prevent you from challenging the denial decision.
Determine the Reason for Your Claim Denial
The insurer has to disclose the basis within the insurance policy and facts relied upon to deny the claim. The insurance policy should disclose the specific policy provisions relied upon to deny the claim. You can obtain your insurance policy from the insurance company. You should review it and make sure to have it available for an attorney to review it. Insurance policies are very complicated.
Get Legal Support
Your lawyer will review your original claim and policy documents to determine whether the reason specified in the denial letter is justifiable. The attorney will identify the additional documentation necessary to strengthen your claim further. They may advise you to get examined by another doctor other than your treating doctor. The attorney may also ask you to complete additional testing like residual functional capacity.
A disability insurance attorney will discuss statutes, procedures, and deadlines applicable to your claim. The attorney will ensure your claim is compliant and error-free. The attorney will poke holes in the evidence presented by your insurer to maximize the chances of a successful appeal.
Your disability lawyer will take your case to court if the insurer rejects your appeal. The lawyer will present compelling evidence and arguments to support your case. This process may involve calling a vocational expert witness to explain your job requirements. It may also involve asking an expert medical witness to explain the impact of your disabling condition on your ability to work.
When Should You Hire a Las Vegas Disability Lawyer?
The best time to hire a lawyer to handle your disability case is soon after suffering a disabling condition that might prevent you from working for a limited period. The lawyer will look at the specific details of your case and advise you on the steps to take.
Don’t wait until you receive a claim denial to hire a lawyer. Involving a lawyer at the initial stages of your claim can help safeguard your rights and interests. It can also allow you to focus on your recovery rather than worrying about deadlines and other legal issues associated with the claims process.
Generally, a disability lawyer will offer you a free phone or in-person consultation or case review. This offer allows you to “shop around” until you find a lawyer who inspires confidence in you.
Don’t worry about the cost of a disability lawyer when thinking about the reasons short-term disability can be denied. These lawyers usually have contingency fee structures. Under these fee structures, you must win the case to pay the lawyer. A contingency fee structure specifies the percentage of your recovery your lawyer will deduct as legal fees. It also specifies who will pay litigation-related costs and how they will get paid. Be sure to review and understand the terms of your lawyer’s contingency fee structure.
“I recently retained the professional services of Matthew Sharp and his law firm to represent my interest in a legal proceeding. Mr. Sharp and his firm shall I say was way over the top in providing excellent and sound legal advice. His professional attitude and attention to detail during the entire process was second to none as well as the rapid and courteous responses from Mr. Sharp and his staff to any and all of my questions regarding my case. Furthermore, I would give my utmost support to anyone choosing Mr. Sharp and his firm in any type of legal representation.”
- RICK S.