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Appealing a Denial of Disability Benefits from Anthem

Osterhout Berger Daley > Insurance Companies > Appealing a Denial of Disability Benefits from Anthem

Many workers in the U.S. opt to purchase disability insurance from Anthem through their employers. This insurance is designed to provide benefits payments when workers are temporarily or permanently disabled and unable to work for the duration of the individual policies. Some workers who have these policies are denied when they try to file claims with Anthem. The experienced disability attorneys at Osterhout Berger Daley help workers to appeal their denials from Anthem.

What is Anthem Blue Cross?

Anthem grew out of two companies that were founded in 1944 and 1946, respectively. The companies drafted a joint operating agreement in 1972 and merged in 1985 to form Blue Cross Blue Shield of Indiana. In 1996, the company changed its name to Anthem Insurance Company. It is headquartered in Indianapolis, Indiana and has more than 37,000 employees. The company sells a wide variety of health insurance products, including disability insurance for workers.

Disability insurance from Anthem

Workers may choose short-term disability insurance, long-term disability insurance or both through Anthem. The company’s short-term disability policies are offered by employers as payroll deductions. This type of insurance is offered for a limited duration after a worker has been forced to miss work for more than a specified number of days. When a worker files a claim for a covered condition, he or she will be referred by Anthem to its 360° Health® management program in addition to receiving benefits. This program is meant to provide care that may return the worker back to his or her job much faster.

Anthem short-term disability insurance

The short-term disability plan pays out benefits on a weekly basis for anywhere between three to six months, depending on your situation. This benefit should cover about 60 to 66 percent of your income. Your disability must be due to a non-work related injury or illness. This does include pregnancy. Keep in mind that if you have other means of collecting disability income, it may reduce your earnings or disqualify you from receiving your benefits from this plan.

Anthem long-term disability insurance

Long-term disability insurance from this insurance company is available on a voluntary basis. This insurance covers workers whose disabilities require them to miss extended periods of time from their jobs. The elimination period for long-term disability coverage is much longer than for short-term disability benefits. With the right policy options, workers may enjoy benefits for years if they are unable to return to work.

Some workers choose to obtain both types of disability insurance from this company. When they do this, they may rely on their short-term disability benefits until its duration ends before their long-term benefits start.

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What you need to know about Anthem claims

It is very common for insurance companies to delay or deny claims in order to avoid paying out benefits. While this doesn’t happen to everyone, it has been known to happen to Anthem claimants. In order to protect yourself from those situations, make sure you fill out your forms completely and accurately. Keep record of all of your documents, including any medical records. If you currently find yourself in one of those situations, it’s best to contact an experienced disability lawyer to help you through the process of moving your claim along.

How to properly submit a claim to Anthem

You can easily submit a short-term or long-term disability claim online. For a short-term disability claim, you’ll need to download and fill out three forms: Attending Physician’s Statement, Individual Authorization Form, and Reimbursement Agreement. After completing those forms, you’ll have to continue filling out information online. Anthem will request information about you, your job, your employer, your disability, your doctor, and any additional income you may have. You’ll then be required to upload the three forms you completed at the beginning of this process. Once you upload those forms, you’ll be asked to confirm that all of the information has been completely filled out. You’ll receive a confirmation summary of your claim after submitting all of the information. Keep a copy of that confirmation with you.

Submitting a long-term disability claim is similar, but the forms that are required may be lengthier than the short-term disability forms. Once again, you’ll have to fill out an Attending Physician’s Statement, an Individual Authorization Form, and a Reimbursement Agreement. You’ll also have to fill out information about yourself, your employer, your job, your disability, your doctor, and any other income you may have. After filling out that information, you’ll be asked to upload the three forms. Confirm that is the information is completely accurate and keep a copy of your confirmation summary for your records.

What to do if Anthem delays your disability claim

It’s been our experience that insurance companies try to delay claims for inadequate reasons. This means that the reasons don’t typically hold up if the insurance company is questioned. The first step you should take in this type of situation is to contact your disability case manager. Ask them to provide you with the reasons for the delay. Most times this alone will move the process along. If that doesn’t happen, you may want to contact a lawyer to help you lift the delay. An experienced lawyer knows the types of questions to ask to move the process along.

What to do if Anthem denies your claim

Anthem notifies claimants that the company has denied their claims by mail. Your letter will contain information about how you can appeal the company’s decision as well as the reasons the company relied on to deny you. It is important for you to read your letter carefully and to note the deadline for filing your appeal.

Appealing a Denial from Anthem

Like other insurance companies, Anthem has its own in-house appeals. You must exhaust their process before you can sue it in court. You should contact the company and ask for a copy of your file. When you receive it, bring your claim file and your letter to your experienced lawyer at Osterhout Berger Daley. Your knowledgeable attorney will review all of your information in order to determine the best strategy for your appeal. You should listen to your attorney and follow his or her advice. Our knowledgeable attorneys have extensive experience helping people to win their appeals, and the advice you will be given will be geared to helping you to win yours. Your attorney might ask you to undergo more tests or medical exams. This is to add evidence to your file to bolster your appeal. Contact the experienced disability team at Osterhout Berger Daley today to learn more about your rights with appealing your denial from Anthem.

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    Learn more about long term disability insurance, as well as appealing denials and how an attorney can help. These five articles will cover the basics: