Kentucky ERISA Disability & Life Insurance Claim Lawyers

Happy Birthday to the Kentucky Unfair Claims Settlement Practices Act! Today marks the anniversary of the enactment of this important law in Kentucky. It holds insurance companies accountable for not paying claims fairly or promptly. With the right attorney on your side, they can be forced to pay all damages from the delay. They can be made to pay punitive damages for being too slow to pay.

We also extend a “thank you” to the lawmakers in our state who voted UNANIMOUSLY to pass this law. It is a uniform law passed in most states. Kentucky allows any claimant who has been treated unfairly to sue for damages. That threat, of being forced to pay for their misdeeds, keeps insurance payments flowing timely. It prevents unfair negotiation tactics and taking advantage of a person at their weakest.

Call Mehr Fairbanks Trial Lawyers today if you have been jerked around by an insurance company. We know what to do, and we get it done for you.

If you receive long-term disability (LTD) insurance as an employee benefit through work, it’s likely that your benefit is governed by the Employee Retirement Income Security Act, also known as ERISA. ERISA is a federal law that applies to all sorts of employee welfare benefits, including health insurance, life insurance, short-term disability insurance, and LTD insurance.

Very generally speaking, if you need to make a claim for LTD benefits, you will be required to go through a claim process with the insurance company. Here are five tips to help make sure you are providing the insurance company with the information it needs for your claim.

1. Explain why you can’t work. This may seem obvious, but you will need to provide specific information about why you are unable to continue working. While an off-work note from your doctor might be sufficient for an excused absence with your employer, the insurance company may need additional information about why you can’t work. Be sure to gather and submit medical records and results from any diagnostic tests. Also, many insurance companies will provide you with fillable forms for you and your doctors to use to explain the basis of your disability.

2. Make sure to get all your information submitted. It’s important to make sure you have provided the insurance company with all the information it needs to make a decision on your LTD claim. If your claim or appeal is denied, you may not be able to submit additional information after the decision is made. As a result, it is imperative to provide all medical and vocational records before the claim process is over.

3. Pay attention to deadlines in letters from the insurance company. ERISA and its regulations set forth certain time limits for both you and the insurance company to follow during your LTD claim. If an insurance company denies your claim, it is required to give you notice of the amount of time you have to submit an appeal. Be sure to get your information submitted before the deadline passes.

4. If the insurance company gives you an opportunity to submit information in response to a medical report it has obtained, take the opportunity to explain your claim. Insurance companies might hire their own doctors to either examine you or to perform a review of your medical records. If the insurance company provides you with a copy of the report before finalizing its decision on your claim, be sure to review the report and submit any additional information.

5. Send in statements from co-workers or family members. Your medical records most often will have information about your medical conditions and why you are unable to work. If you have a co-worker or family member who can explain through firsthand knowledge how your medical conditions are affecting your ability to work or to complete activities of daily living, you can submit statements from those individuals in addition to your medical proof.

If you have questions about your long-term disability claim, contact the attorneys at Mehr Fairbanks Trial Lawyers. Philip Fairbanks, Esq., one of the partners at Mehr Fairbanks Trial Lawyers, wrote this piece. We hope this was helpful, and please get in touch with our firm if you have questions.

Most health insurance plans cover medical expenses if the treatment is medically necessary and not “experimental” or “investigational.” But the health insurance policy documents rarely spell out exactly what treatments the insurer considers experimental or investigational. Instead, health insurance companies will create separate “medical policy guidelines” that their claim examiners will use to approve or deny claims. These medical policies can result in a large number of claim denials if the insurance company has put in place a policy that denies all requests for a certain type of treatment.

If you get your health insurance coverage through your employer (or a family member’s employer), your insurance is likely subject to the Employee Retirement Income Security Act (ERISA). ERISA is a federal law that provides claimants and beneficiaries with a civil enforcement scheme to remedy wrongful denials of coverage.

Under ERISA, a claimant can file a lawsuit to enforce and/or clarify his rights to the benefits at issue. ERISA also allows a claimant to seek declaratory or injunctive relief if a particular medical policy is not consistent with current medical standards. In other words, if a medical policy is faulty and not based on prevailing medical standards, a claimant can ask a court to require the insurer to reprocess a claim using a corrected medical policy. This type of claim reprocessing is a common remedy under ERISA, and courts have the authority to order claim administrators to reprocess claims.

Accidental Death and Dismemberment (also referred to as AD&D or ADD) insurance is a type of life insurance that may provide additional coverage to you and your family if a death is the result of an accident. This means your beneficiaries may be able to recover life insurance proceeds plus additional accidental death proceeds.

While this insurance can be an added benefit, it also has its own exclusions and limitations. Whether a death is an accident or not may sound like a simple enough concept, but insurance companies may still attempt to deny a claim for a variety of reasons such as suicide, intentionally self-inflicted injury, war, inhalation of poisonous gases, commission of a criminal act, use of alcohol or drugs, overdose, or death caused by a disease or sickness. Consider the following: an individual is involved in a motor vehicle accident and tragically dies. Almost universally, everyone would agree the death is the result of an accident, but what if the driver had taken medication that day? What if the driver was speeding? What if the driver had a heart condition at the time of the accident? Another example: someone has an adverse reaction to a medication and unexpectedly passes away. This also would vastly be considered an accident, but what if the person was prescribed too high of a dose? What if the medication reacted with another substance? What if the person had a preexisting medical condition?

Issues like these can make what seems like a straightforward question (accident or not?) more complex. If you have had a claim for life insurance or accidental death insurance denied, contact us for a case evaluation. Many people get their AD&D policies as an employee benefit through their employer. As a result, your insurance claim may be covered by the Employee Retirement Income Security Act (ERISA). Our team of attorneys has decades of combined experience counseling clients and getting results. We have handled accidental death insurance lawsuits for beneficiaries in state and federal court.

Mehr Fairbanks Trial Lawyers teamed up with The Carnegie Center for Literacy & Learning to raise money for their tutoring services. You can read more about the fundraising project here.

Mehr Fairbanks Trial Lawyers promised to match up to $10,000 of any contribution made to the fundraiser. Thanks to several thoughtful donors, MFPTL was able to donate the full $10,000 amount. Pictured below are members of the MFPTL staff and members of The Carnegie Center staff exchanging the $10,000 check, while staying socially distanced. Combined with MFPTL’s contribution, the fundraising campaign raised a total of $26,270 for The Carnegie Center’s tutoring program.

At Mehr Fairbanks Trial Lawyers, we strive to help the community in any way that we can, whether that’s by settling cases for our clients or donating to a fundraiser that is important to our team to help students in our area. We are dedicating to helping you!

Attorney Bartley Hagerman recently settled a premises liability case for $100,000. Our client slipped and fell on ice in a parking lot after getting out of her car and sustained bodily injuries. The lawsuit was settled with the property owner and the snow and ice removal company.

If you or someone you know suffered bodily injuries following a similar incident, click here and begin speaking with one of our attorneys. Our attorneys have years of experience helping our clients recover money that they are entitled to following personal injury and premises liability cases.

Call us today!