Losing a loved one is never easy. Along with the emotional pain comes the financial burdens associated with end-of-life expenses. Covering the costs of these expenses becomes even more difficult when insurance companies deny claims. Read on to learn what to do if an AD&D insurance company chose to deny your claims after the death of a loved one.

Understanding AD&D Insurance

Along with traditional life insurance policies, individuals can purchase Accidental Death & Dismemberment (AD&D) insurance too. AD&D insurance is not the same as conventional life insurance. It is a form of supplemental coverage that can be purchased in addition to traditional life insurance policies. Some individuals choose to use AD&D insurance as a standalone coverage as well.

Unlike traditional life insurance, AD&D coverage only covers accidental deaths. AD&D insurance is intended to cover traumatic deaths such as those that occur due to a vehicle accident. A death that occurs by natural cause is excluded from receiving AD&D insurance coverage. Along with natural death, there are a number of other reasons why AD&D insurance claims can be denied.

Reason Why AD&D Insurance Claims are Denied

AD&D insurance only compensates an individual’s beneficiaries if their death was a result of an accident. This means the insurance company may deny the claim if the individual’s death was a result of the following:

• Death was a result of suicide
• Death was a result of a pre-existing medical condition
• Death was a result of participation in criminal activity
• Death was a result of misusing alcohol or drugs
• Death was a result of intoxicated driving
• Death was a result of physical illness
• Death was a result of mental illness
• Death was a result of military combat
• Death occurred while the insured was driving a vehicle for compensation or hire
• Death occurred while the insured was flying a plane or working as a flight crew member
• Death was a result of an incident that does not qualify as an accident

While there are valid reasons for an AD&D insurance claim to be denied, many insurance companies attempt to undervalue AD&D claims or deny claims for invalid reasons. Oftentimes, AD&D claims are denied without merit but don’t be discouraged. There are steps you can take if your AD&D insurance claim was denied without merit.

What Should I Do If the Life Insurance Company Denies My AD&D Insurance Claim?

Before you make an AD&D claim, be sure to read over the insurance policy carefully. This will give you a clear insight into whether your claim has any merit. If your loved one did die as a result of an accident, you would need to gather all documentation related to the accident and have it ready to submit to the insurance company. This includes all medical records, witness statements, and accident reports surrounding the death. Once you have gathered all the necessary documentation, you should go ahead and file the AD&D insurance claim.

Once the insurance company responds, be sure to keep detailed notes of every conversation and correspondence you have with the company. Write down the name of the person you talk to, the date you spoke to them, and the details of your conversation. If the insurance company decides to deny the claim, this information will come in handy when fighting back against the insurance company’s decision.

If the insurance company does deny your AD&D insurance claim, you must act quickly. There is only a small window of time that you are allowed to fight back against their decision. Most AD&D policies are governed by the federal law known as ERISA. In most cases, ERISA gives an unfair advantage to the insurance company and sets out specific rules and timelines for filing appeals of a denial. If you fail to submit an appeal that meets all ERISA requirements prior to the deadline, you are usually barred from moving forward with a lawsuit against the insurance company.

When AD&D insurance deny claims, appeals and lawsuits can become complicated and overwhelming quickly. Therefore, as soon as you have been notified that your AD&D insurance claim has been denied, you should reach out to an ERISA lawyer immediately. An experienced attorney will be able to help you navigate this difficult situation and help you obtain the compensation you and your family deserve.

Consult with an ERISA Lawyer Today

Dealing with the death of a loved one should not be made more difficult by having to deal with denied insurance claims. You and your family deserve proper representation and compensation. If AD&D insurance deny claims after the death of a loved one, reach out to an experienced ERISA lawyer immediately.

Contact us today to schedule a consultation. We look forward to working with you and helping you obtain the compensation that is rightfully yours.

 

Insurance companies are for-profit institutions, and as such, have an interest in not paying your claim. They know that it is not unheard of for employees to file for disability and exaggerate their symptoms in order to maximize their payout. In an effort to determine if a claim is valid, insurance companies will often utilize surveillance in determining the legitimacy of a disability claim.

How Surveillance in a Disability Claim Works

Texas employers that offer long-term disability insurance will be governed by ERISA law if the coverage is provided through a group plan. Insurers can refuse to pay a claim, and one of the reasons for these refusals is that the applicant is faking or exaggerating their injuries.

As a result, the insurer may engage in surveillance tactics to prove that your injuries are not as you claim.

This can be done through:

Physical Surveillance

Physical surveillance is when an investigator is hired and will follow you around. This individual is looking to prove that your case is invalid. For example, if you suffered an injury to your leg and said that you can no longer squat down to pick up packages at work, the individual will look for instances of you squatting down to pick up your child or packages off your doorstep. The investigator cannot legally go onto your property, but they can be at the same ballgame as you or watch what you’re doing in your backyard.

Electronic Surveillance

Electronic surveillance is growing in popularity thanks to people putting their entire lives on social media. These investigators will look to see if you’ve posted pictures or videos performing activities that you could not have done given the injury or symptoms listed on your disability claim.

Field Visit

Finally, the insurer can send someone to your home to conduct what is known as a “field visit.” These visits are often framed as the person following up and trying to learn more about your case. But when they enter the home, they’ll be scanning the home for anything amiss.

Perhaps in your claim, you mentioned that you cannot do your own house cleaning, so if your home is tidy and you have cleaning supplies out on the table, the insurer may question your symptoms.

Insurers will look for any reason not to accept your claim, even if it’s minor or outlandish. Perhaps you cannot pick up the 50-pound boxes at work that you have to as a mover, but you can pick up an envelope that fell on the floor. Even picking up the envelope may be enough to question your claim.

Of course, you have a right to fight back against claim denials, especially if your case is legitimate.

What Insurers May Also Do to Disprove a Claim

Basic surveillance is a given, but an insurer can go even further in an effort to disprove a claim. The insurer may also:

• Interview your neighbors to determine if they’ve seen you doing anything that can be used to deny your claim.
• Take video or pictures from outside of the home to use as proof against you.
• Follow you in their vehicles.

It’s not uncommon for a claimant to feel like their privacy has been violated and that they must act or behave a certain way. You should not stop your normal routine to prove your case. Instead, you should continue performing your normal activities so long as you’re following your doctor’s advice.

If your doctor advised you that you could go for a light jog, don’t let the surveillance on a disability claim stop you.

Honesty is the best policy when filing a claim, and if you’ve been truthful about your limitations, symptoms, and injury, you really have nothing to hide.

Tips for Dealing with Surveillance

You need to deal with your claim while also living your life. It’s important to do a few things that will allow you to live a life of normalcy without jeopardizing your claim:

• Don’t push yourself. You should not be performing any activities that your doctor has warned you against. It’s important to take it slow and set limitations. Not only can an investigator use your actions against you, but if you don’t continue in your limitations, you risk aggravating your condition and making it worse.
• Stay off social media. If you have a disability claim pending, be sure to stay off of social media. You may post an innocent picture, even from weeks before your injury, and this may be used against you. Also, ask your friends and family to stop sending updates about you or posting pictures.
• Contact a lawyer. Working with a lawyer in Texas that specializes in ERISA disability claims can help you make sense of the surveillance and work towards a claim approval. A lawyer will ensure that the insurance company is acting within their rights and not engaging in any activity that may be illegal and violate your rights.

Surveillance plays a major role in your disability claim. If you notice that the insurer has hired a private investigator, contact a lawyer and be sure to follow your doctor’s instructions rather than push your limits.

Reach out right away for a no-obligation consultation to discuss your disability claim.

If you are looking into the details of your employer-provided benefits, or if you have had a claim denied, you will likely come across the term ERISA. ERISA stands for Employee Retirement Income Security Act of 1974, and it is a set of legislation that was designed to protect workers’ rights when it comes to their benefits.

Like most complex pieces of legislation, its existence came out of a complicated set of events and compromises. It has also seen changes over the years. Understanding the history of ERISA and how it operates today can make filing an ERISA claim easier.

History of ERISA: Understanding the Need

In the 1960s, there was a sharp increase in private pension funds, and that increase nudged President John F. Kennedy to establish the Committee on Corporate Pension Funds in 1962. That Committee would later publish their findings under President Johnson. A summary and analysis of the report explained that “[f]rom 1953 to the end of 1964, the accumulation of assets of private pension funds has grown from 16.9 billion dollars to 75 billion dollars, with a projected accumulation of 225 billion dollars by 1980.”

The Committee foresaw a steep increase in the use of private pensions and cited several causes for this dramatic rise including union pressure to create pension funds, high corporate taxes in conjunction with deductions for pension contributions, and a 1948 court ruling that established pensions as bargainable issues. Writing about the findings of the Committee, the summary explained that “the degree of federal regulation is and has been minimal. This predominantly laissez-faire attitude may be on the wane, however.”

Indeed, it was, and a single company’s failure was a large catalyst for these upcoming changes.

Studebaker-Packard Failure Provided Stark Illustration

Even as the Committee was assessing the need for more regulation in the private pension arena, a stark illustration of their deepest concerns was taking shape. Studebaker was an American car manufacturer based in South Bend, Indiana that had roots back to the family’s blacksmithing days in the 1850s. By the 1950s, they were creating cars known to be reliable and desirable, but their financial situation was not as rosy. In fact, they partnered with Packard and then ceased operations at their South Bend plant in December 1963.

What does this have to do with the history of ERISA? Well, there were 10,500 workers impacted by the closure. The 3,600 who had already retired were able to keep their promised benefits, but around 4,000 workers between the ages of 40 and 59 were not as fortunate. As the ASPPA explains, “They only got about 15 cents for each dollar of benefit they had been promised, though the average age of this group of workers was 52 years with an average of 23 years of service (another 2,900 employees, who all had less than 10 years of service, received nothing).”

There was already a question of whether benefits needed more regulation, and the Studebaker-Packard failure seemed to provide a resounding “YES!”

ERISA Established Protection for Workers

Enacted in 1974, the Employee Retirement Income Security Act (ERISA) helped to provide safeguards against the kind of financial tragedy that impacted thousands of workers in the Studebaker-Packard failure. As the Department of Labor explains, ERISA “requires that sponsors of private employee benefit plans provide participants and beneficiaries with adequate information regarding their plans” while establishing minimum qualifications for those who manage the plans. In addition, ERISA requires reporting to the government and disclosure to participants while establishing provisions that protect funds for participants.

Employers who do not comply with ERISA risk disqualification of the plan and penalties as well as ineligibility for tax benefits.

Changes to ERISA Over Time

Like any piece of complex legislation, changes over time have been necessary to make sure that the Act keeps up with the needs of the day. After nearly 50 years in action, ERISA has certainly seen a lot of changes to the workforce, and amendments to its function have taken many forms, including the following:

• Retirement Equity Act of 1984– Reduced the maximum age that an employer may require for retirement plan participation; lengthened the time period a participant could be absent from work without losing credit
• Omnibus Budget Reconciliation Act of 1986– Barred limits on retirement plan participation for new hires near retirement age; barred the freezing of benefits for participants over age 65
• Omnibus Budget Reconciliation Act of 1989– Established a 20% penalty for recovered amounts due to fiduciary responsibility violations
• Pension Protection Act of 2006– Expanded fiduciary investment advice availability; removed barriers to automatic enrollment; increased transparency

History of ERISA: Still in the Making

ERISA was established within a specific context of the American workforce, and changes to that context have resulted in changes to ERISA itself over the years. We can expect that ERISA will continue to adapt to modern-day workplace demands, but its primary function has remained consistent.

If you have been denied benefits from your employer-provided benefits, an ERISA claim might be your best course of action.

Contact us today to schedule a no obligations consultation.

 

A long term disability can impact your life in a number of ways, including your ability to work and earn an income. While many individuals suffering from disability breathe a sigh of relief knowing that they have insurance to cover it, that relief is quickly replaced by frustration over the complexity of proving that you are eligible for those benefits. If you’re wondering how to prove your long term disability, read on for more information.

The Evidence You Need to Prove for Your Claim

In order to prove that you have a long term disability, you must be able to show that you are disabled according to the definition of the term used by your policy. Different policies have different provisions and even provisions that change after you have collected benefits for a year, two years, or five years. Most policies begin by defining disability as an illness or injury that prevents an individual from doing his or her own job. After a time, disability can come to mean an illness or injury that prevents an individual from doing any job.

The most powerful form of evidence you have to prove your long term disability is the opinions of your doctor and the results of your tests.

How to Prove Long Term Disability

When applying for disability with the insurance company, you will generally be required to submit three forms. Each of these forms requires specific types of information.

The Claimant Statement

The claimant statement is a description of your disabling condition in your own words, why you feel the condition is disabling, and how the disability impacts your day-to-day life. When filling this out, it is important to be as precise as possible. Be sure that the information you are offering in your statement does not present an inaccurate view as to what you are able to do. Often, the forms provided by the insurance company offer only limited space for replies. If you are unable to fit a complete statement about your condition in the space provided, attach an additional page.

You will also have to provide additional information, including authorization for the insurance company to access your medical records and discuss your condition with any doctors who are providing treatment. You will be asked to fill out income statements. Again, provide as much information as possible, remembering to include sources of compensation from other benefit programs as well.

The Employer Statement

This information must be filled out by your human resources department or company supervisor and involves listing your job duties, your salary, the date on which you last worked and other details about your employment. Additionally, once your claim is approved, your employer will be required to furnish periodic updates as requested by your insurer to reevaluate your claim.

The Physician Statement

As stated, the opinion of your doctor and the results of diagnostic tests that your doctor has performed are among the most crucial pieces of evidence that can be provided. Your claim should include a strong combination of both subjective evidence — including the doctor’s view of how your illness or injury affects your daily life and ability to work — as well as objective evidence, such as MRI tests, X-rays, or lab work that reinforces the doctor’s opinion.

It is not unusual for an insurance company to provide forms in which the questions are misleading and can give answers that result in a denial or delay of benefits. Because the physician statement is such an important part of your claim, it is recommended that you schedule an appointment with your doctor around the time when you need to have the physician statement completed. This ensures that you not only have the opportunity to get the form filled out while you’re there, but the opportunity to go through the statement with your doctor to ensure that the information provided is clear.

The FCE

In addition to the above three portions of your long term disability claim, your insurance company can also require you to undergo a functional capacity evaluation (FCE). This evaluation is a battery of tests performed in order to evaluate whether your condition prevents you from working. It is important that you speak with your disability assistance attorney to ensure that you are properly prepared for this evaluation as it is physically exerting and the results can be used to deny your claim.

Let Us Help

The process of filing a long term disability claim is complex, requiring an intense understanding of the legal requirements that the insurance company has to provide you with these benefits, as well as the requirements you have to prove your condition. If you have a disabling condition and you need assistance with your long term disability claim, we can help. Reach out today to schedule a consultation.

 

Obtaining life insurance can sure feel like a complicated process. You are probably asking yourself how does life insurance work and do I even need it? While trying to understand the ins and outs of life insurance can feel overwhelming, it doesn’t have to be that way.

How Does Life Insurance Work?

Obtaining life insurance is never about yourself. It is always about your loved ones. Essentially, life insurance provides compensation to your loved ones when you pass away. The compensation that your loved ones receive after your passing comes from an insurance company, as life insurance is a contract between you and an insurance company. In order for your family to receive compensation upon your death, you will need to make regular premium payments to your life insurance company.

Life Insurance Terminology

One of the reasons life insurance can feel so complicated is because of the terminology that is used. We’re here to help you break down these terms so you can better understand the whole life insurance process.

Premiums

• Premiums simply refer to the payments you make to the insurance company for your life insurance policy.

Beneficiaries

• Beneficiaries are the people who receive compensation from your life insurance plan.
• Beneficiaries are often spouses or children.
• However, you can choose anyone you would like as a beneficiary.

Death Benefit

• The term death benefit refers to the total amount of compensation your beneficiaries will receive upon your death.

Main Types of Life Insurance

Overall, there are two main types of life insurance, term life, and permanent life. Term life insurance covers for a fixed amount of time. Permanent life insurance covers you until the end of your life. Term life insurance is generally cheaper to purchase compared to permanent life insurance. However, term life policies have no value if you outlive the contract.

Here is a breakdown of the two different life insurance policies:

Term Life Insurance

• The most affordable type of life insurance.
• The most popular type of life insurance with 71% of purchasers.
• Typical policy lengths are 10, 15, 20, 25, or 30 years.
• If you pass away within your policy, beneficiaries will receive the tax-free death benefit money.
• If you outlive your life insurance contract, the policy has no value without an additional renewal.
• Often times you can renew your term life insurance policies in increments of one year after expiration.
• Each renewal year of term life insurance will be at a higher rate.

Permanent Life Insurance

• Is the more expensive life insurance policy, as it provides lifelong coverage.
• This insurance policy usually builds cash value over the life of the policy.
• There are multiple varieties of permanent life insurance.

Whole Life Insurance

• Offers a fixed death benefit and cash value component that grows at a guaranteed rate of return.

Universal Life Insurance

• Offers more flexibility compared to a whole life insurance policy.
• Premium payments and the death benefit can be altered with certain limits.
• Cash value will generally build depending on the type of policy.
• Will typically have investment subaccounts that you can choose to manage.

Burial Insurance

• Designed to cover only funeral costs and final expenses.
• Generally provides a small death benefit, often between $5,000 and $25,000.

Survivorship Life Insurance

• Insures two people under one policy, usually a married couple.
• When both spouses pass away, the policy is then paid out to beneficiaries.
• Generally utilized as a part of a larger financial plan to fund a trust or pay estate taxes.

Do I Need Life Insurance?

Life insurance is necessary for anyone who has a spouse, children, or financial dependents. Life insurance is essentially a financial problem solver. Upon your death, you don’t want to burden loved ones with financial struggles. Even if your spouse and children are financially independent, there will be costs associated with your death. Your loved ones will be responsible for paying for your burial and other end-of-life expenses. These are all elements to keep in mind when selecting your life insurance coverage.

Consult with an Experienced ERISA Lawyer Today

If you still have more questions about life insurance or have been denied life insurance benefits in the past, contact an experienced ERISA lawyer as soon as possible. An experienced ERISA lawyer will be able to look at your case, helping you reach your best possible outcome. Reach out today to schedule a free consultation.