Proficient Pennsylvania Disability Lawyers For The Standard Insurance Company
Disability insurance is designed to provide financial support to employees who are unable to work due to illness or injury. In Pennsylvania, employees covered under The Standard’s short-term or long-term disability (STD/LTD) policies may experience a denial of benefits under certain circumstances. Understanding the common reasons for denials and how to navigate the appeal process can help ensure that employees receive the benefits they are entitled to. The Standard Company Disability Lawyer in Pennsylvania at DarrasLaw can help you get the compensation you deserve.
Common Reasons for Disability Insurance Denials
When The Standard Insurance Company denies a disability insurance claim, it is usually for one or more of the following reasons:
1. Lack of Medical Evidence
One of the most common reasons for a denial is insufficient medical evidence to support the claim. The Standard requires comprehensive medical documentation that proves the disability impairs the employee’s ability to work. If the provided documentation does not adequately demonstrate the severity or duration of the condition, the claim may be denied.
- Common issues: Missing or incomplete medical records, lack of a definitive diagnosis, or failure to show how the condition prevents the employee from performing their job duties.
- Solution: Ensure that your physician submits thorough medical records, including test results, treatment plans, and detailed explanations of how the condition affects your ability to work.
2. Pre-Existing Conditions
Most disability policies, including those from The Standard, contain exclusions for pre-existing conditions. This means if you file a claim for a condition that existed before the policy’s coverage period began, it may be denied.
- Pre-existing condition clauses typically cover medical conditions for which the employee received treatment or was diagnosed within a specific period (e.g., 3 to 12 months) before the start of the policy.
- Solution: Review the policy to understand the pre-existing condition clause and work with your physician to provide evidence that the disability was not related to a pre-existing condition or arose after the policy went into effect.
3. Failure to Meet the Definition of Disability
The Standard, like many insurers, has a specific definition of what qualifies as a disability. For short-term disability, this often refers to the inability to perform your current job due to illness or injury. For long-term disability, the definition may evolve over time, starting with the inability to perform your own occupation, and then shifting to the inability to perform any occupation after a certain period.
- Issue: The Standard may deny a claim if it determines that the employee does not meet the definition of disability based on medical evidence or vocational evaluations.
- Solution: Review the policy’s definition of disability and gather supporting documentation from your healthcare provider that clearly outlines your limitations and how they meet the policy’s criteria.
4. Failure to Follow Treatment Plans
If an employee fails to follow a prescribed treatment plan (such as attending medical appointments or following rehabilitation protocols), The Standard may deny the claim. The insurer requires that individuals actively seek appropriate medical treatment to improve their condition.
- Solution: Always follow your doctor’s recommendations and keep detailed records of your treatments, appointments, and any rehabilitation efforts and contact The Standard Insurance Company attorney in Pennsylvania.
5. Insufficient Documentation of Ongoing Disability
For long-term disability claims, The Standard may request ongoing documentation to confirm that the disability persists. If this information is not provided in a timely manner or is deemed insufficient, benefits may be denied or discontinued.
- Solution: Stay in regular contact with your healthcare providers and submit all required documentation to The Standard promptly.
6. Exclusions for Certain Conditions
Many disability policies include exclusions for certain conditions, such as mental health disorders, substance abuse, or conditions related to pregnancy after a specific period. If the claimed disability falls under one of these exclusions, The Standard may deny the claim.
- Solution: Review your policy carefully to identify any exclusions and work with your employer and physician to understand how these may apply to your situation.
How to Appeal a Denial of Disability Benefits in Pennsylvania
If The Standard Insurance Company denies your disability claim in Pennsylvania, you have the right to appeal the decision. It’s important to act promptly and follow the correct procedures to maximize your chances of a successful appeal.
Step 1: Review the Denial Letter
The denial letter from The Standard will explain the reasons for the denial and provide information about how to file an appeal. Carefully review this letter to understand the specific reasons for the denial and gather the necessary information to address the insurer’s concerns.
Step 2: Gather Additional Evidence
To successfully appeal a denial, you’ll need to provide additional evidence to support your claim. This may include:
- Updated medical records from your physician that provide more detailed information about your condition.
- Functional capacity evaluations that demonstrate your inability to perform your job duties or any job, depending on the stage of your LTD claim.
- Second opinions from medical specialists, if necessary.
- Vocational expert opinions that support your inability to work in your occupation or any occupation.
Step 3: Submit a Formal Appeal
The Standard’s denial letter will include a deadline for submitting your appeal (typically 180 days from the date of denial). Prepare a formal appeal letter that:
- Clearly addresses the reasons for denial outlined by The Standard.
- Includes additional medical or vocational documentation.
- References your policy’s definition of disability and explains how your condition meets these requirements.
Step 4: Consider Legal Assistance
If your appeal is denied, or if you’re struggling to navigate the appeal process, consider working with an attorney experienced in disability insurance claims. They can help you understand your rights under Pennsylvania law and the Employee Retirement Income Security Act (ERISA), which governs most group disability insurance policies.
Step 5: File a Lawsuit if Necessary
If your appeal is unsuccessful and you believe The Standard wrongfully denied your claim, you may have the option to file a lawsuit. Under ERISA, you must exhaust the internal appeal process before filing suit in federal court.
Contact The Standard Company Disability Lawyer in Pennsylvania Today
Disability insurance denials can be frustrating, especially when you’re already facing a challenging medical condition. In Pennsylvania, employees who are denied short-term or long-term disability benefits by The Standard have options for appealing the decision. By understanding the common reasons for denials and following a structured appeal process, you can improve your chances of securing the benefits you are entitled to. Contact The Standard Company Disability Lawyer in Pennsylvania for assistance. Be diligent in submitting comprehensive medical documentation, adhering to treatment plans, and seeking our help to navigate the process effectively.
