Disability benefits are designed to provide financial relief for workers who are injured while on-the-job. These benefits are part of an insurance policy, and policy holders are entitled to expect payment as outlined in the language of the policy.
Unfortunately, insurance companies do not always meet the terms of the agreement. In these situations, even those who meet the qualifications required by the policy may have their claim for disability benefits denied or may receive benefits that are lower than adequate.
A case in point: One example of a denial of disability benefits claim. Unfortunately, the wrongful denial of disability benefits is not uncommon. A worker out of California is currently attempting to hold an insurance company liable for a wrongful denial after his initial application was rejected.
The worker states that he was diagnosed with "diabetes, hypertension, diabetic retinopathy, gout, [and] osteomyelitis of the right foot." Upon these diagnoses, the worker applied for disability benefits. His application was denied.
In response to the denial, the worker filed a complaint against the insurance provider with the United States District Court for the Central District of California. In the complaint, he states his resulting disability has left him unable to work and that his situation meets the criteria of the policy. As such, he contends that the denial was unjust.
A look at remedies: Three potential options if your disability benefits are wrongfully denied. Those who are wrongfully denied disability benefits, like alleged in the case outlined above, have options. It is important for policy holders to hold insurance companies responsible for wrongful denials. If successful, the following remedies could be available:
- Disability benefits. Likely the most obvious remedy, those who move forward with a successful claim can receive disability benefit payments. In addition to the approval of payments moving forward, a successful suit can also result in the payment of benefits that should have been granted after the initial application was denied.
- Legal fees. The court may also require the insurance company to cover the cost of the legal fees that accumulated during the case.
- Etcetera. In some cases, the court may also deem that the insurance company should provide additional relief.
The exact remedies granted will vary depending on the details of the case, but this list provides an example of common remedies.
From case example to your reality: The importance of legal representation. Putting together a complaint to counter a denial of benefits can be a complex process. As a result, those in this situation are wise to seek legal counsel to help better ensure their claim for benefits is approved.