No one that has access to a long term disability insurance policy should assume that he or she will always be guaranteed payments, when disabled by a certain physical or medical condition. The introduction of any sign that the policy holder will be disabled should trigger the making of a claim. Yet that claim could be denied. Fortunately, there are certain actions that can be taken by the adult that has been denied expected disability payments.
Possible reasons for a denial
Every insurer should have a sound reason for denying long term benefits to a policy holder. Sometimes the policy holder has failed to go after an updated policy. Insurers will not provide coverage to adults that hold out-of-date policies.
Sometimes an insurance company will say that a given policy does not cover accidents in a specific location. At other times an insurer will say that the person responsible for a given accident lacks the necessary insurance coverage. Finally, there are times when a policy holder could be told that third party claims would not get covered.
What happens following a denial?
Understand that settlement negotiations continue. In other words, your lawyer could continue meeting with negotiators from the insurance company. The denial does not keep any lawyers from seeking to reach an agreement. Such an agreement could expedite removal of the disquieting denial.
Understand, too that the opinion offered by any Personal Injury Lawyer in Milton cannot be offered as the reason for bringing an end to the negotiating process. Neither can it be pointed to as the means for resolving a given case. A judge has the final say, regarding when or how any type of insurance coverage might be denied.
Procedure that policy holder should follow, after learning of a denial.
First, ask for a written explanation of the basis for the denial. In that written request, be sure to site references to any relevant policy provisions. If possible, give examples from the policy holder’s medical record that showcase the serious nature of that same individual’s condition.
Hope for a response from the insurer. In the absence of such a response, follow this recommendation. Write a letter to the adjuster with details of the earlier request. Include mention of the fact that you got no response to that original request. Feel confident that your letter will get placed in the company’s files.
If still denied coverage, the denied policy holder must search for an alternate source of financial assistance. That could come in the form of third party funds. A third party might be held responsible for the victim’s injuries. For example, someone that fell while entering a restaurant might be able to place responsibility on the door manufacturer.