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Appealing a Denial of Disability Benefits from Dearborn National

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

Many of today’s workers who are currently in their 20s will suffer from disabling illnesses or injuries at some time during their working years, preventing them from returning to their former jobs. In order to protect workers, some employers offer voluntary disability insurance policies from Dearborn National that employees can purchase through payroll deductions. While these plans may offer some peace of mind, Dearborn National often denies initial claims for disability benefits that are made by workers. Osterhout Berger Daley is comprised of a team of experienced disability lawyers who are dedicated to helping our clients to recover benefits when they have been denied by Dearborn National.

Background on Dearborn National

Dearborn National is headquartered in Downer’s Grove, Illinois and was founded in 1969. It is a subsidiary of Health Care Service Corporation and currently serves more than 3 million customers across the U.S. The company has more than 1,100 employees and offers a number of different life insurance and other insurance products, including both short- and long-term disability insurance policies.

Disability Insurance from Dearborn National

Dearborn National offers both employer-sponsored and voluntary disability insurance plans. The company offers short-term disability policies that are designed for people who are temporarily unable to work because of disabling conditions following an elimination period. It also offers long-term disability insurance policies with benefits starting after a longer elimination period once the short-term benefits have ended. The long-term benefits may last for different terms of years, depending on the coverage levels selected by the insured. Some workers opt for both types of coverage in order to have more protection and to receive their benefits more quickly.

Dearborn National short-term disability insurance

Short-term disability insurance is available to you in the event that you become disabled for a short period of time and cannot perform your everyday work tasks. If your disability prevents you from working, that will typically mean that you won’t be able to continue receiving a paycheck. You’ll want to be protected in the event that, that happens. Short-term disability insurance will protect up to 60% of your weekly earnings. The exact percentage will depend on your policy.

You’ll want to pay close attention to the following items found in your policy:

  • Waiting period: not every company requires employees to go through a waiting period. In this event yours does, this is a set amount of time that you will have to wait before you’re able to submit a claim to receive benefits. For example, your employer might mandate that you need to wait 90 days from the time you’re hired before you can request any benefits. Check your policy or ask your employer if you’re unsure whether this is a requirement.
  • Elimination period: this is a set amount of time that you’ll need to be disabled before the insurance company will consider granting you disability benefits. You won’t receive any benefits during this time, so you’ll want to make sure that you submit your claim as soon as you’re deemed unable to work.
  • Definition of a disability: you’ll want to find out what Dearborn National considers to be a disability. Not all insurance companies have the same definition when it comes to a disabling condition. For example, some insurance companies may consider cancer to be a disabling condition while other insurance companies may consider that to be a pre-existing condition. Read through your policy carefully to understand what conditions entitle you to receive disability benefits.

Dearborn National long-term disability insurance

Long-term disability insurance is very similar to short-term disability insurance, but benefits are paid out for a longer amount of time. Typically, with short-term disability insurance you’re paid benefits on a weekly basis, but with long-term disability insurance your benefits are paid out on a monthly basis. Your benefits for long-term disability are calculated much in the same way as the short-term plan. You’ll also want to pay attention to the same items in your policy as you would with a short-term disability policy. These items are the waiting period, the elimination period, and the definition of a disability.

What you need to know about Dearborn National claims

Insurance companies tend to find the smallest discrepancies to delay or deny claims. In order to avoid this happening to you, it’s important that you fill out the claim form completely and accurately. It can get a bit overwhelming as multiple parties are required to complete the form, but it’s important to stay on top of this process if you want to receive your benefits in a timely manner. If you feel more comfortable going through this process with some help, seeking an experienced disability lawyer can help alleviate some of the pressure of this process. Our lawyers at Osterhout Berger Daley know exactly what’s required when it comes to submitting a claim and can be with you during every step of the process.

How to submit a claim to Dearborn National

There will be three sections that will need to be completed: an employer section, an employee section (this is for you to complete), and a physician section. The forms are fairly similar for both short-term and long-term disability. There may be some authorization forms that will differ between the two, but the process is fairly similar. There are instructions that come with each section of the form detailing the documentation that is required to be submitted with the claim form. The instructions also detail the steps in which the form should be completed. You’ll want to be sure that you follow these instructions carefully and don’t miss any steps. Any incompleteness could give the insurance company a reason to delay or deny your benefits.

What to do if Dearborn National delays your disability claim

If you believe that the insurance company is delaying your claim, you’ll want to reach out to a representative of the company to check on your claim’s status. If you still feel as though your claim is being delayed and no real answers have been given to you, you may need to seek legal help. Experienced disability lawyers know how to detect whether insurance companies are unfairly delaying claims by recognizing common tactics such as asking you an obscene amount of questions without moving your claim status forward. Having a lawyer on your side could prevent the insurance company from performing these ludicrous tactics and help you receive your benefits in a timely manner.

What to do if Dearborn National denies your disability claim

Dearborn National often initially denies claims for disability benefits, and it notifies the claimants of its decision by letters sent to them in the mail. If you receive a denial notice, it will tell you why they company has chosen to deny your claim and explain how to appeal its decision. It is important for you to note the deadline for filing your appeal. ERISA mandates that you must first appeal the decision internally before filing a lawsuit, and if you miss the deadline, you will be barred from later trying to recover your disability benefits. Once you receive your denial, ask for the company to give you a copy of your file. It will include all of the evidence that Dearborn National used to deny your claim. If your claim is not approved after you appeal via the internal process, it may be time to appeal the denial in court by filing a lawsuit against the insurance company.

Appealing a denial from Dearborn National

Our team of experienced attorneys.

When you come to meet with one of the experienced attorneys at Osterhout Berger Daley, bring your denial letter and your claim file with you. Your knowledgeable lawyer will review the information that is contained in your file and make recommendations about what you should do. It is important that you are honest with your lawyer and with your doctor about the severity of your symptoms. If you are not honest or try to exaggerate your symptoms, it is likely to backfire, making it more difficult for you to win your appeal.

Your attorney will give you advice about what you should do, and he or she may ask you to attend additional medical appointments, submit to additional medical exams or get additional objective medical tests such as MRIs or others. It is important for you to follow through with these recommendations. Your attorney will likely be trying to build additional evidence in your claim file for your appeal that supports the basis for your claim. By doing so, he or she may be able to secure a favorable outcome for you without your needing to sue Dearborn National. Contact the professional team at Osterhout Berger Daley today to learn more about the rights that you might have.

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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: