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Appealing a Denial of Disability Benefits from The Rawlings Group

Osterhout Berger Daley > Insurance Companies > Appealing a Denial of Disability Benefits from The Rawlings Group

If you have disability insurance through your employer or an individual policy, you may believe that you will be protected if you suffer a disability and are no longer able to work at your job. Some insurance companies have paired up with the Rawlings Company, and you may receive a notice from it. If your claim is denied or your disability benefits are reduced, you may need to get legal help from the experienced disability lawyers at Osterhout Berger Daley.

Background on The Rawlings Group

Founded in 1977, the Rawlings Group is headquartered in La Grange, Kentucky. The company provides subrogation and recovery services to insurance companies, including Aetna and others. It is focused on post-payment claims recovery for insurance plans, including disability insurance claims.

Disability insurance from The Rawlings Group

The Rawlings Group does not offer disability insurance itself. Instead, it represents companies that do sell short- and long-term disability insurance in an effort to recover money that has been paid out on claims. Short-term disability offers payments for durations lasting weeks or months while you are unable to work. Long-term disability offers payments lasting for several years or up to age 65.

Understanding short- and long-term disability insurance

Short- and long-term disability insurance is meant to help those who are unable to work due to an illness or injury. Unfortunately, it can often be difficult to receive these benefits right when you need them most. Short- and long-term disability plans often come with elimination periods that require you to wait a certain amount of time before you can start collecting benefits. The amount of time you’ll have to wait during this elimination period will be dependent on what your employer and insurance company agreed upon. The elimination period will be longer for long-term disability plans than for short-term disability plans, but if you opt for both disability plans, you can often start your elimination period for the long-term plan while your collecting benefits for the short-term plan.

Another extremely important item to pay close attention to is how your insurance company defines a disability. There may be certain illnesses and injuries that your insurance company will consider to be a pre-existing condition rather than a disability. For example, you may find yourself unable to work because of a herniated disk in your back. The insurance company may consider a back injury to be a qualifying disability, but may list herniated disk under pre-existing conditions. Understanding whether your injury or illness is considered a disability by your insurance company will increase your likelihood that you’ll receive the benefits you need.

Understanding how The Rawlings Group fits into disability insurance

The Rawlings Group is “the industry leader in recoveries”, according to its website. The company claims that it “consistently recover[s] more money for [its] health plan clients than any other competing vendor in the industry, and [it has] been doing it for longer than any other vendor has been around.” What does this mean? This means that the company has successfully lessened insurance companies’ financial obligations to its disability insurance claimants.

How has The Rawlings Group been able to do this? Well, let’s say that your insurance company considers a back injury to be a qualifying disability, you file a claim, and the insurance company grants you benefits. The insurance company may continue to investigate your case after you’ve already been granted your benefits. If the insurance company finds that your back injury was the result of a car accident, not a work injury, and that you received compensation through a third-party, the insurance company may hire The Rawlings Group to recover the benefits it has already paid out.

What you need to know about The Rawling Group intercepting disability claims

Another way that insurance companies may use The Rawlings Group is during the claims process. Using the same example as above, if you’re filing a claim due to a back injury and the insurance company hires The Rawling Group because the insurance company has a suspicion that you received the injury from a non-work related incident, you may receive a letter from The Rawlings Group on behalf of the insurance company. This letter may ask you provide more information regarding your injury and that you sign an authorization form allowing The Rawlings Group to gain access to your private information. If you have filed a claim and have received a letter from your insurance company, or The Rawlings Group on behalf of your insurance company, that demands information is provided to the Rawlings Group, you may need to get legal help.

What to do if The Rawlings Group tries to deny my disability claim

When you send in your claim for benefits, you may receive a letter that tells you that you need to provide more information about your accident. This letter may indicate that the Rawlings Group is trying to determine whether your injury or accident was caused by another third party. If your claim with your insurance company was already approved, the goal of the Rawlings Group will be to try to reduce your benefits by either claiming that you owe your insurance company money or that a third party is responsible and should pay you. If your claim is denied or your benefits are reduced, it is important for you to bring in your notice to the Osterhout Berger Daley firm.

Our team of experienced attorneys.

Appealing a denial from The Rawlings Group

Our team of experienced attorneys may help you to recover the benefits that you should have been paid or to appeal your denial. During the process, you should limit how you communicate with your insurance company and with the Rawlings Company about your claim to writing. You should also continue getting medical care for your condition, and your attorney may ask you to seek additional evaluations, exams and tests. If your appeals within your insurance company are exhausted, your lawyer may then file a lawsuit against it in court. If you are forced to file a lawsuit, you will be limited to using the evidence that is contained in your claim file. This makes it very important for you to add as much favorable evidence as possible to your file.

The Rawlings Group specializes in recovering money for insurance companies, and it mines data to try to reduce payments to beneficiaries. If you are contacted by them, you may need to get help from one of the experienced disability lawyers at Osterhout Berger Daley. We understand how this company works and are able to anticipate the tactics that it uses. We are able to help you through your company’s internal appeals process. If necessary, we can litigate the issues on your behalf in court if the internal appeals are denied. To learn more about the Rawlings Group and your disability insurance policy, call us today to schedule a consultation with one of our knowledgeable disability attorneys.