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Aflac disability insurance provides critical financial protection for people facing unexpected health challenges. However, navigating the claims process can be daunting, with denials being a common frustration for policyholders. Understanding the reasons behind Aflac disability denials is key to understanding how to navigate and potentially overcome these obstacles.
Policyholders often find themselves in a difficult position when their disability claims are denied, impacting their financial stability and peace of mind. Understanding why these denials occur and how to address them is essential for those who rely on Aflac disability insurance. In this article, we will explore the most common reasons for Aflac disability denials and strategies for effectively managing these situations.
By shedding light on the complexities of Aflac disability insurance claims and denials, policyholders can arm themselves with the knowledge and insight needed to successfully navigate the process successfully. Stay tuned as we explore valuable tips and guidance to help policyholders tackle Aflac disability denials with confidence and clarity.
Aflac Disability Insurance Overview
Aflac disability insurance provides essential financial protection in the event of illness or injury, offering peace of mind by securing your income during difficult times. Let’s take a closer look at what Aflac Disability Insurance is and the types of coverage options it offers.
What Is Aflac Disability Insurance?
Disability insurance is designed to provide individuals with a safety net by replacing a portion of their income if they are unable to work due to a covered illness, injury, or disability. This coverage is designed to ensure that policyholders can continue to meet their financial obligations and maintain their standard of living without added stress during difficult circumstances.
Types of Disability Coverage Aflac Offers
Aflac offers several types of disability insurance coverage to meet different needs and situations. The two primary categories are short-term disability (STD) and long-term disability (LTD), which Aflac offers only through employers.
- Short-Term Disability (STD) Coverage: This type of coverage provides benefits for a limited period of time, usually up to six months, following a qualifying disability. STD plans typically provide a higher percentage of income replacement than long-term disability plans.
- Long-Term Disability (LTD) Coverage: Long-term disability insurance comes into play when a disability or illness extends beyond the period covered by short-term disability benefits. LTD policies provide income replacement for an extended period of time, often until the individual reaches retirement age or is medically able to return to work. This coverage provides a more permanent financial cushion for policyholders facing long-term disabilities or chronic health conditions.
Individuals can purchase Aflac riders, such as cancer insurance and critical illness insurance, directly from Aflac. Aflac also acts as an administrator for some disability insurance policies issued by Zurich American Life Insurance Company.
Common Reasons for Aflac Disability Denials
Receiving a denial on your Aflac disability claim can be frustrating and overwhelming. Let’s take a closer look at the common reasons policyholders may experience denials.
Failure to Meet Policy Requirements
You must meet all the medical and non-medical requirements outlined in your disability insurance policy, such as the elimination period and work hours requirement. Aflac will deny your claim if you do not meet the terms of your policy. Review your policy to determine what Aflac expects of you as a policyholder and fulfill all obligations to be eligible for benefits.
Insufficient Medical Evidence
A key factor in supporting your disability claim with Aflac is providing comprehensive medical evidence. Inadequate documentation or vague medical records can result in claim being denied because insurers rely heavily on this evidence to assess the validity of your disability. Gather all relevant medical records, tests, and reports to effectively support your claim.
Pre-Existing Condition Exclusions
Pre-existing conditions can be a challenge when applying for disability benefits with Aflac. If your disability is related to a pre-existing condition that falls under the policy’s exclusions, your claim may be denied. It is important to understand how pre-existing conditions are defined in your policy and how they affect your eligibility for benefits. Understanding these exclusions can help you navigate the claims process more effectively and avoid potential denials.
Disability Definition Changes After 24 Months
Long-term disability policies often change the definition of disability after the first 24 months of benefits. Insurers do this to make it more difficult to qualify. Instead of being unable to do your job, you must be unable to do any job for which you are reasonably qualified.
For example, we have seen Aflac disability denials and policies using the following language:
“How Do We Define a Long-Term Disability?
During the elimination period, and the first 24 months benefits are payable, you are disabled when we determine that:
- You are unable to perform the material and substantial duties of your regular occupation due solely to your sickness or injury;
- You are under the regular care of a physician; and
- You have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.
After monthly payments have been payable for 24 months, you are disabled when we determine that due to the same sickness or injury:
- You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience;
- You are under the regular care of a physician; and
- You have a 40% or more loss in your indexed monthly earnings due to the same sickness or injury.”
This stricter standard causes many legitimate claims to be denied. People are cut off from critical income when they are still too disabled to earn a living wage.
Appealing an Aflac Disability Denial
As frustrating as receiving a denial letter can be, don’t lose hope. You have the right to appeal this decision, which allows you to provide additional information to support your case and potentially overturn the denial. Understanding the appeals process will help you effectively navigate this challenging situation.
Understanding the Appeals Process
When appealing an Aflac disability denial, it’s important to follow a structured approach. Start by understanding the steps involved, including gathering medical records, doctor’s statements, and any other pertinent documentation that supports your claim. Pay close attention to deadlines, as missing them could jeopardize your appeal.
Don’t Try to Skip Filing an Administrative Appeal
You can’t file an ERISA lawsuit unless you first exhaust all appeals with your insurer. The appeals process is mandatory—there are no exceptions. Don’t skip it and go straight to court, or the court will dismiss your case. Follow the proper channels, fill the record with evidence that supports your claim, and increase your chances of getting the benefits you deserve.
Appealing Your Claim Denial in Federal Court
If your appeal to Aflac is unsuccessful, you can take your case to federal court. The legal process can be complex and time-consuming, and your case becomes a matter of public record. Consulting with legal experts who specialize in disability insurance claims can provide invaluable guidance on whether pursuing this route is the best course of action for your specific situation.
Why You Should Work With An Experienced Attorney to Appeal a Denial
Navigating the complexities of a disability claim denial can be overwhelming, especially if it is governed by ERISA, but working with an experienced ERISA attorney can help:
- An experienced ERISA attorney is well versed in the intricate web of regulations and procedures set forth by the Employee Retirement Income Security Act (ERISA). They understand the nuances of ERISA law and can guide you through the process with confidence and clarity.
- When facing a disability denial, it is critical to have an attorney who knows how to strategically approach appeals and potential litigation. An experienced ERISA attorney can evaluate your case, develop a sound legal strategy, and effectively advocate for your rights.
- ERISA claims have strict deadlines and specific requirements that must be met to ensure a favorable outcome. By working with an experienced attorney, you can maximize your chances of success by submitting all required documentation accurately and on time.
Call an Aflac Disability Denial Lawyer Today
If you’re struggling with a denied disability claim from Aflac, don’t worry—expert legal help is available.
Nick Ortiz, a national long-term disability attorney with extensive experience fighting for the rights of the disabled since 2005, can provide invaluable assistance. At the Ortiz Law Firm, you get a free case evaluation and only pay an attorney’s fee if we recover your benefits—that’s our “No Recovery, Zero Fee” guarantee.
Don’t navigate the complex world of disability insurance denials and appeals alone; contact us online or call (888) 321-8131.