Frequently Asked Questions

If your life insurance gets denied, you should retain or request the following documents:

• The written denial letter with specific information on why your life insurance claim was denied
• The complete claim file, including any documents that were generated during the insurance company’s investigation
• The life insurance policy and the Summary Plan Description (SPD) that was in effect at the date of death
• The plan document along with any amendments that could affect your coverage or eligibility

When you discuss your situation with an Alabama life insurance attorney, they can help you seek additional documentation to help with your appeal.

Yes, you can appeal a denial of life insurance benefits even if your policy is governed by ERISA. Keep in mind that ERISA complicates the appeals process. There are strict administrative deadlines and procedures you need to follow.

When you hire an ERISA life insurance attorney in Alabama, they can provide an overview of the ERISA appeal process and help you understand what steps you need to take next.

Under Alabama Administrative Code Rule 482-1-124-.04, the following practices and timeframes apply:

• The insurer must provide the necessary forms and instructions within 15 days of receiving notice of a claim.
• The insurer must start processing the claim within 15 days of receiving proof of loss.
• Upon receipt of proof of loss, the insurer must affirm or deny the claim or inform the claimant that the claim is under investigation within 60 days.

If your life insurance claim gets denied, you have options to appeal. Don’t assume that the denial letter is the final chapter of this story. Our Alabama law firm recommends taking these steps:

• Retain that denial letter or request a written explanation of why your claim was denied. Written correspondence about your denied claim should include the specific policy provision, exclusion, or condition that resulted in the denial; any supporting documents for the denial; and a deadline to request an appeal.
• Review your life insurance policy carefully.
• Speak with an Alabama life insurance attorney as soon as possible. A lawyer can clear up any misunderstandings and let you know the best steps to take next. You can also work with the attorney to prepare your appeal.

Insurers have own-occupation and any-occupation standards when determining whether you are eligible for disability benefits.

• Own Occupation: This means that you are unable to perform the duties of your own job, even if your disability allows you to work a different job.
• Any Occupation: This means that you are unable to perform the duties of any occupation based on your experience and training.

Own-occupation standards tend to be more favorable for those who are insured.

Policies and standards differ, and some policies use a hybrid approach. That means the own-occupation standard may only apply for the first 24 months before shifting to the any-occupation standard.

It’s important for an Alabama disability attorney to note these standards when assessing a client’s health condition and the justification for a claim denial.

A functional capacity evaluation (FCE) and clearly worded medical records are among the most important documents to include in your disability claim appeal. Your FCE is especially important as it evaluates and assesses your physical abilities and limitations related to work.

Your Alabama disability claim attorney can help you obtain strong evidence that establishes the severity of your condition and how it impacts your ability to work and earn a living.

If your disability benefits get denied, our law firm recommends gathering the following documents to help with your appeal:

• A copy of your disability insurance policy and plan documents
• The denial letter
• The insurer’s complete claim file
• Your medical records and any treatment notes from your doctor(s)
• A description of your job and regular work duties

There may be other documents required to build the strongest appeal possible. In fact, you may need to see another doctor for new documentation and testing or get a detailed description of what you do for work and how your condition has impacted your ability to work from your supervisor.

Your Alabama disability denial attorney can review your claim and help you obtain the key documents and evidence needed to improve your chances for a successful appeal.

It depends on your disability coverage and whether your policy is governed by ERISA.

• For ERISA disability claims, you usually have 30 to 180 days to file for an administrative appeal starting on the date you receive the denial letter.
• For non-ERISA claims, you may have anywhere from 30 to 90 days to file an appeal. The deadline will be noted in both the denial letter and/or your individual insurance policy.

As soon as your claim gets denied, contact an Alabama disability insurance attorney about what happened. Your lawyer can let you know the best steps to take next.

Potentially, yes. The insurer providing long-term disability coverage may claim that they have overpaid your benefits since you are also receiving income through Social Security Disability. They may try to claim your SSDI lump sum payment, and also offset future LTD coverage based on the income you receive through SSDI.

Learn more about long-term disability overpayment and offsets.

Yes, if you’ve exhausted your short-term disability benefits, you may be able to apply for long-term disability benefits. Usually this happens after you’ve had an extension of your short-term disability benefits.

To go from short-term to long-term disability, you will need to meet the stricter eligibility requirements of the long-term disability coverage and provide medical evidence that you are unable to work long-term. It may also be possible to apply for Social Security Disability Insurance (SSDI) depending on your work history.

The answer varies. This usually depends on who pays the premiums and when they are paid.

• If you pay for the premiums with your after-tax dollars, your short-term disability benefits are not taxed.
• If your employer pays for all of the premiums, your short-term disability benefits are taxed.
• If you split premium payments with your employer and your share is deducted from your paycheck, your short-term disability benefits are taxed.
• If you split premium payments with your employer and your share is paid with after-tax dollars, half of your short-term disability benefits are taxed.

Maybe. This depends on your short-term disability policy, the nature of your part-time work, the number of hours worked, and how much income you’d earn. Double-check your short-term disability policy before considering any part-time employment.

If you are permitted part-time work, you will likely need to report all work activities to your insurance provider and your employer.