INSURED RIGHTS® is a service created by Grabhorn Law to educate and empower real people to better prepare and pursue successful insurance claims.
The adage that knowledge is power definitely applies to insurance claims. Whether you are pursuing a disability, life, or accidental death insurance claim (or any type of insurance), the more you know about the terms of your insurance policy and the claims process, the more successful you will be with your claim. In our experience from having collectively worked in the insurance industry for over 36 years, insurance companies are only too happy to answer your questions when selling you an insurance policy or enrolling your for coverage. Then, the insurance company’s answers grind to a halt. So where can you turn for answers? Where can you turn for help with your insurance claim? What questions should you be asking? How can you protect your insurance rights and improve your chances of a successful insurance claim? To answer these questions, and more, Grabhorn Law created Insured Rights™ as a resource and service for real people (the consuming public). Through this website, including articles, news, and tips and its legal services, Grabhorn Law strives to educate and empower real people to better protect their Insured Rights™ – the goal being to better prepare and pursue successful insurance claims.
Your education should not stop when you purchase an insurance policy.
Before you purchase an insurance policy, as with any significant purchase, you should research the insurance company and the available policies in the marketplace. Ask questions from the insurance company and its representatives (agents). But, the problem is, many people stop asking questions when they purchase an insurance policy. Your questions should continue, even if the insurance company is not very cooperative. Continue to educate yourself about the insurance company and your insurance coverage. Review news and reviews concerning insurance claim issues and concerns. Periodically check your state department of insurance for complaints or notices involving the insurance company and its policies. The time to do your research is not after your claim is denied.
Read, ask, and document.
When you received your insurance policy, do not simply file it away until needed. Read it. Read all of it. Often the insurance company will provide you a summary of your insurance coverage. The summary is often referred to as a declarations page or schedule of benefits. Think of it as the cliff note version of the insurance policy. It should clearly and accurately inform you of the insurance coverage being provided, as well as any limitations, exceptions, or exclusions. But that is not always the case. That is why it’s so important for you to read the entire insurance policy.
Make a note of each confusing phrase and term. If anything in the policy is different than the schedule of benefits, or what you thought you were buying, hi-lite it. Then, ask the insurance company to explain and to clarify. Ask the insurance company to confirm your understanding of the insurance coverage, including any limitations, exceptions, and exclusions. Do this in writing. Submit your questions in writing, and demand the insurance company respond in writing.
Become a hoarder and keep everything.
There are times when being a hoarder – a paper rat – is a good thing. Documenting your insurance coverage is one of those times. You should keep a file for each insurance policy, whether you buy it directly or through an employer or association. This includes keeping all marketing materials. Save anything you receive from the insurance company and its agents (i.e. brochures, flyers, sales materials, proposals, notes, etc.). Keep it all. To this file, add your application, any examination reports, the insurance policy and all amendments/notices. Save all premium notices, premium payments, and correspondence (print out emails and texts). Again, keep it all. You will need these documents if there is ever a dispute.
Educate yourself about your state and federal insurance rights.
Each state has a department of insurance, a consumer rights advocate, or both. These agencies should be able to give you some basic information on your insurance rights, including how to file a regulatory complaint if warranted. Similarly, on a federal level, the U.S. Department of Labor has a division that handles issues involving ERISA (“Employment Retirement Income Security Act”) benefit claims.
Not all insurance coverage is the same.
It seems obvious that disability insurance is not the same as life insurance, just as homeowners insurance is not the same as car insurance. Each type of insurance coverage has its own unique rules, terms, and claim requirements – as well as insured rights. By way of example:
- Life insurance has strict rules governing the replacement of prior coverage. When followed by the insurance company and it agents, these replacement rules limit how long the new policy must be in-force before it is no longer contestable. Typically, if the prior insurance policy was in-force for at least two years, the new policy is not contestable. However, insurance companies routinely contest insurance policies regardless of the replacement rights. If you’re unaware of these protections, your beneficiary’s claim will likely be denied.
- Disability insurance policies often have a pre-existing limitation (similar to health insurance) whereby if you file a claim within 12 months (more recently 24 months) of becoming covered, the claim is automatically denied. While several state insurance departments prohibit this practice, insurance companies continue to deny disability insurance claims.
- Many disability insurance companies also aggressively seek to reclassify disability insurance policies as being subject to ERISA, as opposed to state law. When successful, as they often are, the insurance companies significantly reduce their financial liability and shift the legal system to their advantage (avoiding a real trial, avoiding a jury, and limiting your rights).
Knowing your contractual rights under the insurance policy, as well as under applicable state and federal law, is critical to a successful claim.
Insured Rights® provides the education, experience, and legal help necessary to prepare and obtain a more favorable claim result.
The learning curve for insurance and ERISA claims is steep – even with the ready availability of information on the internet. Assistance from an experienced and qualified law firm is critical, whether with the initial claim, the appeal, or (as is more common) the lawsuit. Just as you should investigate and educate yourself about the insurance company, you should do the same with any lawyer. Ask questions. Then, ask more questions. For example, you should know:
- What experience does the lawyer has with the insurance industry, specifically with disability or life insurance claims?
- Has the lawyer completed the necessary education and training to receive a CLU® professional designation?
- Can the lawyer explain how ERISA could impact your claim?
- Is the lawyer familiar with the regulatory guidelines for insurance claims, including ERISA?
- What are the different deadlines applicable to disability versus life insurance claims?
Make sure you get complete answers to all of your questions before making a decision. Then contact Grabhorn Law and ask the same questions. Rest assured, we have the answers to your questions – even the questions you have not asked, but should.