Did you sustain an injury or illness that’s preventing you from earning an income? Did you purchase an individual disability insurance policy and don’t know what to do next? If so, contact Fusco, Brandenstein & Rada, P.C., and we’ll assist you with your claim for benefits. Disability insurance provides wage replacement for workers who are unable to return to work due to a disabling medical condition. We have the experience and resources to ensure the insurance company treats you fairly and provides the maximum payments you deserve.

Individual disability insurance is for people who don’t have coverage through their employer or want additional protection on top of another policy. If you purchase a plan directly from the insurance company, you’ll need to follow state laws, unlike employer-paid disability that falls under federal laws.

Fusco, Brandenstein & Rada, P.C. will provide support and guidance through the entire claims process. Our New York individual disability claims lawyers are ready to take your call and help you recover the benefits you need to compensate your losses. Call us today at 516-496-0400 to schedule a free consultation.

What Is an Individual Disability Policy?

Individual disability plans protect a person’s income when they become disabled and can no longer work. You can purchase a short-term or long-term policy by paying a monthly premium directly to the insurance company. Individual policies include special provisions, exclusions, and other factors that could affect coverage. The most common provisions include:

  • Noncancellable: The insurance company isn’t allowed to cancel your policy or change anything included in the coverage, such as your monthly premium.
  • Own-occupation provision: This refers to your eligibility for benefits if your medical condition prevents you from working in your job industry despite the ability to perform duties at another place of employment.
  • 90-day elimination period: If you become disabled, you must wait at least 90 days before collecting benefit payments.

Every insurance policy lists qualifying injuries and illnesses. If you can find your non-work-related condition on the list, you’re likely eligible for benefits. Disabilities covered by most individual disability insurance plans include:

  • Kidney disease
  • Musculoskeletal disorders, such as osteoarthritis and rheumatoid arthritis
  • Cancer
  • Loss of vision or hearing
  • Respiratory illnesses, such as cystic fibrosis and chronic obstructive pulmonary disease (COPD)
  • Mental health disorders, such as depression, anxiety, and schizophrenia
  • Skin disorders, such as psoriasis and eczema
  • Neurological disorders, such as Parkinson’s disease and multiple sclerosis (MS)
  • Cardiovascular diseases
  • Immune system disorders, such as lupus and polymyositis
  • Digestive tract conditions, such as Crohn’s disease and inflammatory bowel disease
  • Hematological disorders, such as sickle cell disease, thrombosis, and lymphoma

There are also exclusions that could prevent you from coverage if you sustain specific injuries or contribute to your disabling condition. Examples include:

  • Alcohol or substance abuse
  • Self-inflicted harm
  • Criminal behavior
  • Civil rebellion or disobedience
  • Preexisting condition
  • Accidents occurring on the job
  • Normal pregnancy
  • Suicide attempt

Short-Term Disability vs. Long-Term Disability

The period when someone collects benefit payments is known as the benefit period. Short-term policies will provide coverage for a disability that lasts anywhere from three to six months. For long-term benefits, your disability must last longer than a year. These provisions can vary from one policy to the next, so you must review your disability plan to determine whether you qualify for short-term or long-term coverage.

Every policy contains an elimination period that indicates how long you have to wait before your benefits begin. Typically, the elimination period for short-term disability is around 14 days, while long-term disability requires at least 90 days.

The amount and duration of your payments will depend on your average monthly income before the disability occurred. Short-term plans pay up to 50% of an injured workers’ wages for a maximum of twenty-six weeks. For long-term disability, coverage is available at 60% to 80% of pre-injury wages. Payments can last for several years or the rest of the disabled individual’s life.

What You Should Do After An Accident Causes a Disability

If you get hurt or sick and end up with a disability, there are steps you should take to protect your rights to benefits from your individual disability plan. Sometimes, insurance companies take months to review a claim and determine whether you deserve coverage for your lost wages. If you begin the application process immediately after the incident, you could save some time.

Step 1: Contact your insurance company to notify them of your disability. Do it in writing and make a copy for yourself, so there’s a record of it. They will provide a claim packet that includes instructions for filing a claim and forms you’ll need to complete. Be sure that the information you provide is accurate and complete. You could end up with a denied claim if you write down conflicting details or submit an incomplete form.

Step 2: Go to the doctor. They will evaluate your condition and provide a diagnosis. They should write a physician statement that includes your disability, how it occurred, the date it began, how it affects your job abilities, and a treatment plan. Follow up with other medical providers and continue medical treatment until they release you from their care.

Step 3: Write an employee statement to include with the application. Most insurance companies require that you complete one.

Step 4: Obtain copies of your medical records and other documents associated with the disabling condition. Evidence can prove that you suffered an injury or illness that keeps you from your job. You can also include a copy of your job description to show the specific impairments that prohibit you from earning an income.

Step 5: File your claim. Provide all completed forms, medical evidence, and other necessary documentation. Your insurance company will review everything to determine if you deserve benefit payments.

Step 6: Hire a New York individual disability claims attorney. We can handle every step of the process on your behalf, so you don’t have to take on the burden alone.

Handling a Denied Claim

If the insurance company denies your disability claim, it’s not the end of the road for you. There are options available to appeal the decision, so you receive the benefits you deserve. Fortunately, state laws allow you to file an appeal and provide additional evidence that proves you have a disability.

Your New York individual disability claims attorney from Fusco, Brandenstein & Rada, P.C. will assist you with this procedure. Appeals are complex. They’re even more complicated than the initial claims process. You have to comply with deadlines, fill out additional forms, and communicate with the insurance company. We’ll ensure there’s a thorough investigation into your injury or illness and collect sufficient evidence to prove you’re unable to work.

When you receive the denial letter, it will include the reason the insurance company denied your claim and instructions for filing an appeal. We’ll read the letter and documents you sent to determine if anything’s missing or there’s incorrect information. Crucial evidence we can use to appeal the decision include:

  • Affidavits from friends and family who saw the impact of your disability on daily life
  • Opinions from vocation, medical, and disability experts
  • Copy of your job description
  • Records from additional medical treatment and testing performed
  • Missing evidence from the original claim
  • Physician letters

Common Causes of Denied Individual Disability Claims

Most people with coverage under an individual plan end up with a denied claim. Sometimes the insurance company provides a valid reason; other times, there was a mistake or oversight that led to the denial. The most common reasons for denied claims include:

  • Failure to attend a required consultative examination
  • You submitted inaccurate or incomplete documents
  • You have a partial disability instead of a total disability
  • Insurance bad faith
  • The insurance company’s doctor disagrees with your initial doctor’s diagnosis
  • The incident that caused your injury or the injury itself is on your policy’s exclusions list
  • Your condition doesn’t match the definition of disability

Why Choose Fusco, Brandenstein & Rada, P.C.?

Our New York individual disability claims attorneys have the experience, knowledge, and resources to fight for the benefits you deserve. We’ll use aggressive tactics to ensure the insurance company pays what they owe you. We know you need these benefits to supplement your lost income and afford medical treatment. You can depend on us to build a strong case that gets you the results you want.

At Fusco, Brandenstein & Rada, P.C., we provide our clients with dependable legal services, guidance, and support. We’ll stay by your side throughout the entire claims or appeals process. We have a proven track record of helping disabled workers recover the maximum disability benefits available. With ten office locations, you’ll never have to travel far to see us. We believe in providing excellent customer service and make sure to return all calls within 24 hours.

If you have an individual disability insurance plan and need help filing a claim or appeal while you’re unable to work, call us at 516-496-0400. One of our New York individual disability claims attorneys will meet you for a free consultation to discuss your options. There’s no risk to speak with us about your situation and determine the best course of action moving forward.

Last Updated : January 10, 2022

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