Claim Denials and Appeals with Federated Disability Insurance

Long-term disability insurance provides financial protection by providing income replacement when medical conditions prevent you from working. Federated Insurance is one of the disability insurance companies that offer such policies. However, having a policy that may cover you does not automatically guarantee that your claim will be approved.

In this article, we will examine the possible scenarios in which a disability claim could be denied by Federated Insurance and discuss the subsequent administrative appeals process. If you need specific legal advice, contact a qualified long-term disability attorney for a free case evaluation.

About Federated Insurance

Founded in 1904, Federated Insurance has a long history of providing insurance solutions to businesses and individuals. While it began as a mutual insurance company serving the retail hardware industry, it has since diversified to offer a wide range of insurance products, including long-term disability insurance.

The Anatomy of Claim Denials

Applying for disability benefits is more than just filling out a form; it’s a complex process influenced by various laws, such as the Employee Retirement Income Security Act (ERISA) for employer-sponsored policies.

To receive benefits, you must meet the definition of disability and any other requirements specified in your insurance policy. Here is an example of how a Federated Insurance policy defines “total disability”:

“You’ll be considered totally disabled if because of sickness or injury:

1. You are under the regular and personal care of a physician; and
2. You are unable to perform the substantial and material duties of your regular occupation: and
3. You are not engaged in any other occupation for wage or profit; and
4. You are unable, after the first 3 years of your total disability, to work in any occupation for which you are suited through education, training, or experience.”

Common Reasons for Denial

1. Unsubstantiated Medical Claims: One of the leading causes of denial is a lack of sufficient medical evidence to support your disability claim.
2. Policy Exclusions: Every policy contains clauses that exclude certain conditions from coverage. If your disability falls under these exclusions, your claim will likely be denied.
3. Late Reporting: Policies often specify a required time frame for reporting your claim or providing a Notice of Disability. Failure to report your claim within the required time frame may result in a claim denial.
4. Documentary Inconsistencies: Any inconsistencies in your medical records, work history, or other documents may be grounds for denial.

Roadmap for Appeals

The denial of a disability claim is not the end of the road. You have the right to appeal the decision, but you must be careful and methodical during the appeal process.

Evaluate the Denial

Your first step after receiving a denial letter from Federated Insurance is to understand why the denial occurred. The denial letter will outline the specific reasons that will guide your appeal strategy.

Gather Additional Evidence

A strong appeal often involves gathering additional information that addresses the gaps or weaknesses identified in the denial letter. This may include more detailed medical evaluations, expert testimony, or witness statements.

RELATED POST: Viso v. Federated – Claimant Failed to Provide Proof of Disability

Legal Assistance: Don’t Go It Alone

The appeals process can be fraught with tricks and traps that can further jeopardize your claim. Consulting with a long-term disability attorney can help you understand the landscape and develop an effective strategy.

Submitting Your Appeal

Take time to gather the evidence you need to support your appeal, but be sure to submit your appeal within the timeframe outlined in your denial letter. Your appeal package should include new evidence, required forms, and a legal brief if you have retained an attorney.

Await a Decision

Upon receipt of your appeal, Federated Insurance will reconsider your claim in light of the new evidence. Regulatory guidelines dictate the timeframe within which they must make a decision.

Call the Ortiz Law Firm to Discuss Your Federated Insurance Disability Claim Denial with a Long-Term Disability Attorney

A Federated Insurance long-term disability claim denial is discouraging, but this is no time to give up. The key to a successful appeal is understanding the nuances of your policy, the reason for the denial, and the legal landscape that governs disability claims.

Engaging a specialized long-term disability attorney can provide invaluable expertise in navigating these challenges and potentially securing the benefits you need. We welcome the opportunity to evaluate your claim and assist you in the appeal process—call (888) 321-8131 today to schedule your free case evaluation.