Disability insurance policies are a contract between the insurer and insured. If the policy terms are not strictly adhered to, one can risk denial of the claim. When filing a claim for disability insurance, the claimant needs to prove the disability through medical evidence and comply with contractual deadlines established by the disability policy. Disability insurance policies have important deadlines that if not met, can be a basis for the denial of that claim. There are deadlines established for when the claim should be filed, providing evidence of disability and also when an appeal can be made if the claim was denied.
When a claimant has more than one type of disability insurance, there may be different timelines for notification and submission of evidence. Most people have employer-based disability insurance coverage, as well as private short-term and long-term disability policies. Each policy will have its own deadline that must be met with. Each benefit may require specific documentation and evidence. There may be different notification requirements and deadlines for each of the policies. One should ensure strict compliance so that there is no reason for the insurer to deny the claims.
The case of Allison Pfifer v. Sedgwick Claims Management Services, Inc. illustrates the importance of complying with the terms of a disability insurance policy. Pfifer’s policy was denied by her short-term disability insurance provider, Sedgwick, when one of her treating physician’s was not able to complete her claims forms within the deadline provided. Pfifer then appealed the denial of her short-term disability claim. However, the claim denial was upheld because Pfifer’s appeal lacked sufficient medical records to support the short-term disability claim.
When Pfifer tried to file a claim for long-term disability benefits, these were also denied on the basis that Pfifer had not exhausted her short-term disability benefits, which was a condition for eligibility. Her appeal of this decision was also denied. Pfifer then filed a civil action that she lost when Sedwick filed a Summary Judgment motion.
Sedgwick argued that the Pfifer’s claims were time-barred according to the terms of her insurance contract. The court found that the six-month limitation period to file a civil action was reasonable and enforceable. Pfifer missed the deadline following the completion of the appeal of her short-term and long-term disability benefits.
If you are in the process of claiming disability insurance payments, it is important to evaluate all the benefits you may be entitled to and analyze how these benefits are interrelated so that one can comply with the requirements of each policy. If you need assistance in interpreting the terms or are unsure of how the claims process works, seek expert advice.
For disability appeals and actions, contact the Pittsburgh disability insurance lawyers at AlpernSchubert P.C. to represent you. For a free consultation, contact us online or call us at 412-765-1888. Located in Pittsburgh, we provide representation to clients throughout western Pennsylvania, including Allegheny County, Lawrence County, and Washington County.