Income Protection Insurance Lawyers
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What is Income Protection Insurance?
Income protection insurance pays benefits if you are unable to work. The terms and benefits vary, depending upon your policy. An income protection policy may cover periods of disability (due to sickness and accidents) or a period of unemployment. However, most income protection insurance policies focus on disability.
If you qualify for income protection benefits, you will receive monthly benefit payments that may cover:
- A percentage of your lost income,
- Mortgage and loan payments, and
- Insurance premiums and other fees.
Depending on the insurance policy, you may receive short-term or long-term benefits.
Unlike Social Security, workers’ compensation, or unemployment benefits, a private insurance company issues an income protection policy or contract. Different policies may have different terms, conditions, and procedures. Make sure you understand your insurance policy’s requirements before filing a claim.
You can request a copy of the insurance policy or its Summary Plan Description (SPD). These documents include the policy’s definitions, procedures, deadlines, and other important information. If you need help understanding the policy or SPD’s language, consider contacting an insurance lawyer.
What if the Insurance Company Refuses to Pay Benefits?
Insurance companies deny benefits for many reasons. You may be denied benefits if:
- You do not meet the policy’s definition of disability.
- You refuse to cooperate with the insurance company’s investigation.
- You do not follow your doctors’ advice or treatment recommendations.
- You refuse to file for Social Security benefits.
- You return to work.
If the insurance company denies your claim, you have appeal rights.
During an appeal, you must prove that you meet the requirements of the insurance policy. You must have evidence supporting your claim, which may include medical records, doctors’ opinions, vocational information, and other data.
The appeal process varies, depending on whether the policy was self-funded or employer-funded. If the policy was self-funded, the case is governed by your state’s contract and insurance laws. But, if the policy was employer-funded, it may be covered by the Employee Retirement Insurance Security Act (ERISA).
In an ERISA-based appeal, you must file an administrative appeal with the insurance company before filing a lawsuit. During the administrative appeal process, you may submit additional evidence supporting your claim, including medical records, doctors’ opinions, and written argument. The insurance company will review your appeal and issue another opinion.
If the insurance company again denies your claim, you may file a lawsuit with the federal courts. However, the court is limited to reviewing the evidence submitted to the insurance company—you cannot provide any new or additional evidence once the insurance company’s decision is final. You also cannot demand a jury trial. Depending on the language of the policy, different standards of review may apply in your case.
ERISA claims involve strict filing deadlines and procedural rules. If you need help getting your income protection benefits, consider contacting a lawyer. A lawyer can guide you through the process and assure that you meet the legal filing requirements.
If your income insurance policy is personally funded or is not otherwise covered by ERISA, the appeals procedure is different. Depending on your policy, you may not have to file an administrative or insurance company-level appeal. You may also be entitled to a jury trial.
What if the Insurance Company Drops a Client from Coverage?
- Failure to pay insurance premiums,
- Fraud or misrepresentation, or
- Filing of excessive claims.
In most states, the insurance company must provide notice of the termination.
However, the insurance company cannot terminate your benefits because you filed a lawsuit or for other discriminatory reasons. Some cancellations of insurance coverage are appealable. If you need help evaluating your claim, contact a lawyer or your state’s insurance commission.
Can a Lawyer Help with an Income Protection Insurance Claim?
Yes. Many people find insurance claims and appeals difficult to handle alone. Insurance claims require a detailed understanding of the law, your policy, and medical evidence. There may be strict filing, notice, and procedural requirements. An employment lawyer can evaluate your case, guide you through the appeals process, and help develop your evidentiary record.
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Last Modified: 10-18-2016 11:28 AM PDT
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