On the Ortiz Legislation Agency, we perceive how irritating it may be when an insurance coverage firm wrongly denies your incapacity declare. A working example is a latest attraction we dealt with for a Navy Federal Credit score Union customer support consultant whose short-term and long-term incapacity advantages have been each in query by New York Life Group Profit Options.
Our consumer struggled with debilitating migraines that have been so extreme that she was unable to work. She adopted her medical doctors’ suggestions and underwent varied assessments to rule out different attainable situations. Nevertheless, whereas a few of these assessments got here again ‘regular’, others confirmed precisely why she was unable to work.
Sadly, her short-term incapacity supplier, New York Life, cherry-picked the data that suited them and used the ‘regular’ take a look at outcomes as a purpose to disclaim her declare, whereas ignoring the medical proof that proved she was certainly disabled throughout that point.
Regardless of this denial, our consumer remained underneath the care of her medical doctors and progressively improved. As her migraines turned much less frequent and extra manageable, she returned to work. Nevertheless, this didn’t change the truth that she was entitled to short-term incapacity advantages for the time she was unable to work.
Whereas making ready her attraction of the short-term incapacity denial, we seen one thing else. Her time away from work wasn’t simply restricted to only the short-term incapacity interval—it additionally overlapped right into a month that certified her for long-term incapacity advantages. So, we took motion. We appealed her short-term incapacity denial and filed a separate declare for long-term incapacity advantages for the time her incapacity prolonged past the short-term protection.
What occurred subsequent illustrates the irritating inconsistency that may include coping with incapacity insurance coverage suppliers. Whereas New York Life continued to search for causes to disclaim her short-term incapacity declare, the long-term incapacity supplier noticed the scenario clearly. They acknowledged that our consumer was too sick to work and authorised her one month of long-term incapacity advantages with out hesitation.
Mockingly, the approval of her long-term incapacity advantages compelled the short-term incapacity supplier to rethink. They reluctantly authorised her full short-term incapacity advantages after her long-term incapacity had already been authorised.
This case illustrates the significance of getting an skilled authorized workforce to assessment your incapacity declare from all angles. Generally, what looks like a easy short-term incapacity denial can have broader implications. With out cautious assessment and motion, our consumer might have missed out on the advantages to which she was entitled to throughout her restoration interval.
If you end up in an identical scenario coping with denied incapacity advantages, don’t go it alone. Insurance coverage corporations typically overlook important particulars, however on the Ortiz Legislation Agency, we don’t. We are going to combat for the advantages our purchasers deserve. Contact us if you happen to need assistance together with your declare. We’re right here to assist.
