You have spent months providing the insurance company with forms and medical records and letters from your doctors, all saying the same thing: You are disabled and can’t work. Yet, the insurance company does not or will not believe you. Perhaps you feel as though you have been hitting your head against a brick wall. As if being made to feel like a fraud and going without an income for so long wasn’t enough, they’ve now told you, in no uncertain terms, that they will not pay your benefits because you are not disabled. You doubt anything you or your doctors can say or do will convince them otherwise. What now?
You have a few options. The first is to continue to bang your head against the wall and provide the insurance company with new information (if you have any), in the hope that all that head banging will result in a different outcome and the insurer will decide that they will pay you your benefits, after all. The second option is to give up and walk away from your disability claim. You have tried hard enough and you are not well and dealing with the insurance company is literally sucking the life out of you. You want to preserve what energy you have to deal with your health and just get through each day. The third option is to find a lawyer to help you fight the insurance company. Perhaps you never imagined having to be involved in a legal battle or you may be worried that a lawsuit will be too stressful and costly. You also have no idea where to find a lawyer who specializes in disability law. None of the three options make you feel particularly hopeful, so which do you choose? The answer will depend on what it is that you want.
To help in your decision, let’s consider the pros and cons of each option.
1. To appeal or not to appeal, that is the question.
When the insurance company denies your claim, they may offer you the option to appeal their decision. Sometimes they provide you with a list of documents or evidence that they would consider on appeal. They might also give you a deadline by which you must submit your appeal. An obvious “pro” of appealing your claim is that, if you are approved, you will receive your benefits without the hassle, cost, stress and time of a lawsuit.
Unfortunately, that is a big “if”. In many cases, if the information you provide is not new or overwhelmingly convincing (and sometimes even if it is), you will be denied again on the appeal, after going to the effort and aggravation of providing the additional information. Another “con” to consider is the fact that the insurance company may actually find new reasons to deny your claim based on the new information you provide to support your appeal. They will then use that information against you if you bring a lawsuit, down the road. Finally, even if your claim is approved on appeal, you will still have to deal with the insurance company going forward and they may “cut off” your benefits, before you are able to return to work.
2. Throw in the towel.
There are definitely “pros” to walking away: you no longer have to deal with your case manager or all the demands for information; nor do you do you have to worry about proving yourself or going through the rigours of a lawsuit. You may think that by giving up, you will have more time rest and more energy to focus on treatment so that you can return to work one day. These may seem like good reasons to give up, however, what if your condition does not improve as you had hoped?
Giving up has a number of “cons”, some more obvious than others. Perhaps people have told you that the insurance company is counting on the fact that most people won’t fight the denial of their disability claim; that denying a claim is part of the company’s business model; that they take advantage of the fact that you are sick and that you will find the prospect of fighting them too overwhelming. Whether or not that is true, you (and/or your employer) paid premiums for a policy and you are entitled by law to benefits if you are disabled according to the terms of the policy. If you give up, the insurance company is guaranteed to keep all those premiums and save the cost of paying you out your benefits. That simply isn’t fair or just. Not to mention, that by giving up, you will be without income; unable to work due to your disability; and your employer may terminate your employment, saying you’ve abandoned your job, since the insurance company says you’re not disabled and you have not returned to work. Giving up could also result in aggravating your medical condition or causing additional illnesses such as depression and anxiety.
3. Fight for what is right.
Once the insurance company denies your disability claim, you can start a lawsuit. In most cases, you are not required to appeal. In fact, you have only 2 years to bring a lawsuit. After which, you are out of time and lose the option to sue them. The “cons” of starting a lawsuit is that you may be intimidated by the process because you don’t know what to expect; you may worry about how stressful it will be; how long it will take; how much it will cost; where to start to even look for a lawyer who specializes in disability claims; and there is the worry of what happens if you do sue them and you lose.
While those are all legitimate concerns, the “pros” of contacting a lawyer and deciding to fight for what you are entitled to is empowering and will result in a settlement that reflects your entitlement under the policy. However, finding a compassionate and experienced lawyer, specializing in disability law, will ease your stress by taking on your fight, allowing you to focus on your treatment and health. A good disability lawyer should be able to answer your questions directly and honestly and provide you with a realistic view of your case and provide you with all the information you need to make good decisions throughout your lawsuit. While it may take time to reach a settlement, if you are disabled, a disability lawyer (which is different than a personal injury lawyer) can aggressively fight the insurance company to obtain a fair and reasonable result, which you would not get if you gave up.
