Lawyers Fighting Denied LTD Brain Injury Claims
When you found out your insurance company denied your long-term disability (LTD) brain injury claim, you likely felt a pit in your stomach as you read the denial. You are probably fearful of mounting medical bills and wonder what you will do to cover them. It is important to remember that you are not alone in this journey.
At Kantor & Kantor, we are people helping people, and with our expertise in LTD brain injury claim denials, we are here to provide you with the guidance and representation you need to navigate the appeals process effectively.
We understand a brain injury’s profound impact on every aspect of your life, including your ability to work and support yourself and your family. Our dedicated team of attorneys offers compassionate support, strategic advocacy, and unwavering commitment to securing the compensation you rightfully deserve. Contact us at 818-886-2525 for a free consultation.
If your LTD claim for a brain injury has been denied, Kantor & Kantor is here to help. We understand the overwhelming feeling accompanying such a setback, leaving you unsure of your next steps. Rest assured, we have the expertise to guide you through this challenging situation. Call us for guidance today at 818-886-2525.
Types of Insurance Denials
Brain injuries can happen in any number of ways: a car accident, a fall, a bicycle accident, a work injury, serious illness, or even medical malpractice, among other causes. Depending on the circumstances of your injury, the type of insurance you depend upon to cover the costs of your brain injury will vary. You may file an individual disability insurance claim, or if your insurance is through your employer, you will file a claim through your health plan. Workers’ compensation may cover you if your injury happened on the job. If your injury keeps you from being able to handle daily activities for an extended period, you may need to file a long-term disability (LTD) claim.
Just as a health insurance company may deny a brain injury claim, an LTD insurer may do the same. If you need LTD, part of your regular income will be paid while you are not working. While the insurance coverage is better than nothing, it usually pays roughly two-thirds of your regular income. LTD can be a lifeline to individuals and families saddled with health care bills who lack the income needed to pay those bills.
Are Brain Injuries Considered a Disability?
Brain injuries typically arise from significant head trauma, causing damage to the brain itself rather than surface wounds. Often dubbed “invisible” injuries, brain injuries manifest a broad spectrum of disruptive symptoms that may not immediately surface and are challenging to substantiate.
The intricate nature of these symptoms varies in intensity from individual to individual, complicating the process of seeking disability benefits. While rehabilitation may show improvements over time, full recovery from brain damage is far from guaranteed. In many instances, individuals suffering from brain injuries may never regain the capacity to work full-time.
Some of the profound, life-altering challenges posed by traumatic brain injuries include:
- Cognitive Symptoms: Brain injuries entail difficulties with cognition, including impaired thinking, reasoning, problem-solving, and both short- and long-term memory loss. These challenges significantly hinder the ability to recall crucial information, organize tasks, and manage routine responsibilities such as employment or household duties.
- Behavioral Symptoms: Brain injuries often damage brain regions controlling mood, judgment, and social aptitude, resulting in emotional and behavioral alterations. Affected individuals may undergo drastic shifts in temperament, exhibiting irritability, aggression, impulsiveness, impaired judgment, and struggles to maintain interpersonal relationships.
- Physical Symptoms: Contrary to common belief, brain injuries extend beyond psychological and emotional realms, often manifesting in physical constraints that impede daily functioning, employment, and mobility. Examples include persistent headaches, balance disturbances that make independent walking arduous, fatigue, insomnia, heightened sensitivity to stimuli, and seizures.
Why Insurers Deny LTD Brain Injury Claims
Chances are good that the reason your insurers gave for their denial of your brain injury claim is not unique. When insurers unfairly or unjustly deny claims, they may do so in “bad faith.” Sometimes, insurance companies try to save money through avenues other than outright denial. They may delay payment of a claim for far too long. Or they may pay a claim but not provide the full payment a person’s benefits require.
Some justifications an insurance company may rely to unfairly or unreasonably deny your claim include:
- Improper Medical Documentation: Insurance companies heavily rely on medical records to assess the validity of a brain injury claim. Inadequate or improperly documented medical records may lead to a denial. It is essential to ensure that your medical documentation clearly outlines the diagnosis, treatment plan, and impact of the brain injury on your daily life. Incompleteness in medical records can raise doubts about the severity and nature of your brain injury. Ensure that your medical records include all relevant details, such as diagnostic tests, treatment history, and expert opinions. Any gaps in the documentation may provide insurers with grounds for denial.
- Records of Your Symptoms Not from the Time of Your Injury: Timeliness is critical when presenting evidence for a brain injury claim. If there are discrepancies in the timeline of your symptoms and the documented time of injury, insurers may question the connection between the brain injury and your reported symptoms. Thoroughly documenting the progression of symptoms from the time of the injury is crucial for a successful claim.
- Errors in Your Claim Forms: Sometimes, insurers may deny claims based on errors or omissions in the initial claim forms. It is crucial to review your claim forms thoroughly and rectify any inaccuracies promptly. Addressing these errors can help prevent unnecessary claim denials.
Even if you feel that some of the rationale your insurance company gives for the denial of your brain injury claim is valid, do not give up. You need experienced legal guidance from attorneys adept in handling insurance bad faith cases.
Insurance companies count on your taking their denial as the last word. You can and should fight your denial. Brain injury treatment can be very expensive, and you may be unable to work for a long time (if ever again) while you recover. This is the time to seek help from an insurance lawyer and fight for your full claim payment.
What to Do if Your LTD Brain Injury Claim Is Denied
Facing a denial of your LTD brain injury claim can be disheartening, but it is crucial to understand that it is not the end of the road. Many insurance companies deny so many claims that it seems like denial is the default. They are in business to make a profit, and that means saving money wherever they can.
Taking decisive and strategic actions in response to the denial is essential for maximizing your chances of a successful appeal. Here is a guide on what to do to improve your chances of getting your disability benefits approved.
Medical Test Results
A crucial element for a successful LTD claim revolves around objective medical evidence and test results. Physicians rely on CT scans or MRIs to check the brain for signs of damage, swelling, or hemorrhaging. These diagnostic findings serve as tangible proof of disability and shed light on lingering mental and cognitive impediments hindering work capability. Additionally, a neuropsychological assessment may be pivotal to pinpoint brain areas affected and gauge the extent of impairment.
Medical Evidence
Beyond mere test outcomes, comprehensive medical documentation is essential. A mere doctor’s note will not suffice. Crucial paperwork includes hospital records, imaging results, records of medical consultations, follow-up visits, and medication histories. Specialist consultations for physical or cognitive rehabilitation should also be documented.
Validation of Debilitating Symptoms
Brain injuries can wreak havoc, and the gravity of physical and cognitive symptoms must not be overlooked. It is crucial to communicate all symptoms to your physician, as documented symptoms are vital in substantiating the severity of impairment. Maintaining a personal journal detailing symptoms can provide a chronological narrative, supplementing clinical assessments and illustrating the impact of symptoms on daily functioning.
Demonstrate That You Are Receiving Appropriate Treatment
Insurance adjudicators scrutinize the appropriateness of treatment to gauge the credibility of claims. Inadequate treatment relative to the injury or disability can jeopardize a claim’s approval. Adhering to a tailored recovery regimen under specialized care and following referrals or treatment plans prescribed by physicians bolsters credibility. Proactively adhering to medical advice enhances the likelihood of claim approval and reduces the risk of denial.
If the system is against you, what should you do if your brain injury claim is denied? Do you have any chance to get it paid? Yes, you do!
Your best course of action is to work with attorneys who have a thorough knowledge of insurance laws. At Kantor & Kantor, we can guide you on the steps you should take if your claim is denied. We will explain what documentation you need to fight the denial, and we will help you secure that information.
Appealing an LTD Brain Injury Claim Denial
The appeal process allows you to present additional evidence, clarify misconceptions, and strengthen your case. Here is how to navigate the appeal process effectively:
- Carefully Review the Denial Letter: Begin by thoroughly examining the denial letter. Understand the specific reasons cited by the insurance company for denying your LTD claim. This information will guide your appeal strategy, helping you address each point of contention.
- Gather Comprehensive Medical Evidence: Strengthen your case by collecting thorough and up-to-date medical records demonstrating the extent and impact of your brain injury. Include diagnostic reports, treatment plans, and expert opinions from qualified medical professionals familiar with brain injury cases. Review the records you receive to make sure they contain accurate and complete information. You have the right to ask your provider to correct inaccurate information in your medical records.
- Seek Expert Opinions: Consult with specialists who can provide expert opinions regarding the nature and consequences of your brain injury. Neurologists, neuropsychologists, and other relevant medical experts can offer valuable insights and bolster your appeal by clearly understanding the severity of your condition.
- Document Functional Limitations: Clearly outline how your brain injury has affected your daily life, including your ability to work, perform routine tasks, and engage in social activities. Document any functional limitations you experience from the injury, emphasizing the impact on your overall quality of life.
- Write an Appeal Letter: Draft a comprehensive appeal letter addressing each reason for denial. Clearly articulate your arguments, supported by the gathered medical evidence and expert opinions. Present a compelling narrative that emphasizes the severity of your brain injury and the need for disability benefits.
- Follow the Applicable Timeline: Adhere strictly to the deadlines outlined in your insurance policy for filing an appeal. Missing these deadlines could jeopardize your ability to overturn the denial. Initiate the appeal process promptly to maximize your chances of success.
- Consider Legal Representation: Given the complexity of brain injury cases and insurance law, seeking legal representation is often advisable. If the process seems daunting or you do not know how to proceed, contact an experienced LTD insurance claim denials attorney to guide you through the appeal process.
Why Choose Kantor & Kantor?
Denied LTD Brain Injury Claim Attorneys With a Proven Track Record
You have many choices before you for legal representation when an insurer has denied your claim for brain injury treatment. There are many reasons why your best decision is Kantor & Kantor. Our strong record of winning cases is one in which we have contested unfair denials and litigated many in court.
- We Are People Helping People. Our compassionate team knows you are going through a very difficult time. Our team will not treat you as just another file number, as testimonials from past clients show. You are a human being in a very scary, difficult situation, and you need support from attorneys with expertise in brain injury insurance claim denials.
- Comprehensive Understanding of Medical Complexities: Securing LTD benefits for brain injuries requires a nuanced understanding of medical complexities. We collaborate with medical experts to build compelling cases, presenting the necessary evidence to establish the severity and impact of traumatic brain injuries.
- Our Work Impacts Laws That Protect People Like You: Our legal filings at the federal circuit courts and the U.S. Supreme Court level have helped make insurers treat policyholders fairly when evaluating claims.
- We Are the Attorneys That Judges Turn to For Help: Clients, other attorneys, and even judges seek our legal support and advice. Once you know that our colleagues in the legal profession come to us for help, your decision should be easy: get Kantor & Kantor on your side immediately.
- We Will not Settle For the Easy Way Out: Rather than do the hard work to get you the best outcome possible, other law firms may want fast results and opt for quick settlements. We are always ready to take your case to court.
- Our Denied Brain Injury Claim Attorney Is Ready to Help You Now: Put your mind at ease sooner rather than later. Call us at 818-886-2525, and you will get a free 30-minute consultation.
How We Can Help With Your Case
If your LTD claim for a brain injury has been denied, our experienced team of attorneys is here to provide the support and guidance you need. Here is how we can help.
Comprehensive Case Evaluation
Upon reviewing your denied claim, we will thoroughly evaluate your case to identify the reasons for the denial and develop a strategic plan of action. Our team will meticulously gather relevant medical evidence, review policy provisions, and assess the strength of your claim to build a compelling case on your behalf.
Medical Expert Collaboration
Proving the severity and impact of a traumatic brain injury as a disability requires collaboration with medical experts. We have established relationships with a network of healthcare professionals specializing in brain injuries. These experts are crucial in providing comprehensive assessments, opinions, and testimony to strengthen your case.
Strategic Appeals Process
Successfully appealing a denied LTD claim involves a strategic approach. Our legal team is well-versed in the nuances of the appeals process and will guide you through each step. From gathering additional medical evidence to addressing any administrative errors, we ensure that your appeal is presented in the most compelling manner possible.
Negotiation and Litigation Skills
Our legal team is skilled in negotiation and, if necessary, litigation. We are prepared to engage with insurance companies to advocate for your rights and negotiate a fair resolution. If litigation becomes unavoidable, we have the litigation experience required to pursue your case in court, providing you with the comprehensive legal representation needed to secure the benefits you deserve.
Is Your Insurance Employer-Provided?
Your Brain Injury Claim Denial May Be Covered by Federal Law
Our attorneys at Kantor & Kantor focus on insurance law and help clients in California, where our offices are located, and across the country. One area of law in which we have exceptional knowledge and skill is ERISA law. ERISA is the Employee Retirement Income Security Act; it was initially passed to protect the retirement benefits of employees but was later expanded to cover policyholder protections, too. For ERISA to govern the actions of your insurer, your disability insurance must be administered through an employer-sponsored plan. If you get your disability insurance through work, ERISA is likely to apply to your case.
If ERISA covers your brain injury claim denial, you need an attorney with detailed knowledge of this area of law. This is just one more reason to choose Kantor & Kantor. Our attorneys have deep and unsurpassed expertise in this area of law. We are the attorneys that can help you obtain the benefits your policy provides, and your insurer denied.
If you do not have health coverage through your employer, you live in California, and your claim for payment of a brain injury claim is denied, state laws apply. The California Insurance Code is complex, but our attorneys understand how state law governs claim denials. We not only handle cases governed by CA law, but we also provide legal expertise to clients in other states.
Contact an LTD Insurance Claim Denials Attorney Today
We Are the Law Firm Insurance Companies Fear
Our accomplished attorneys have extensive expertise and a long history of battling insurance companies for our clients. The companies know our record of winning. They know we will not take a low-ball settlement offer and that we always prepare a case as if it will go to trial. What is more, when we go to court, we win. Contact us today at 818-886-2525 for a free consultation. Let us guide you through the appeals process and fight for the compensation you deserve.
Turn to our team at Kantor & Kantor today. You will be thankful you did. Call us at 818-886-2525 for your free, 30-minute initial consultation.
