Our North Carolina Disability Lawyers Can Help
There are millions of people across the country living with disabilities. Statistics published by the Centers for Disease Control and Prevention (CDC) suggest one in four Americans has a disability. Our North Carolina disability lawyers know that for some individuals who suffer from a physical or mental disability, obtaining income through a job is difficult or impossible. However, many private companies offer group disability insurance policies that can help cover expenses due to an inability to work. Self-employed workers may purchase individual policies that provide similar benefits. Disabled veterans can also access benefits through the VA.
Unfortunately, insurers or the VA may deny these claims and make it very difficult to appeal denied claims. Tucker Law Group is a nationwide disability law firm that can assist you by providing representation for an appeal. Additionally, if you need help filing or litigating for disability insurance benefits, our firm may be able to help you.
How We Help
Group Disability Insurance Policies and ERISA
Do you have a group disability insurance policy through a private employer? If you have such a policy, then it is likely covered by the Employee Retirement Income Security Act of 1974 (ERISA). This federal law has certain requirements for private employers who administer these policies. Your employer must inform you of how your policy works, what it covers, and any significant changes made to your coverage or eligibility.
ERISA claims can be confusing. The requirements for filing, appealing or litigating for benefits may be difficult to understand. We encourage you to read our FAQ section on ERISA to learn more about how the law could potentially affect your case. You can also contact us to set up a consultation.
Individual Disability Insurance Claims in North Carolina
ERISA is a federal law that covers group disability policies. If you have an individual disability policy, then North Carolina state law is responsible for governing the claims and appeals process. Much like with an ERISA plan, your policy should outline the claims and appeals process requirements. Your insurance company must provide this information.
You may be able to file an appeal for benefits if you receive a denial. During this time, you should consider working with an attorney who can help you gather crucial medical evidence and strengthen the merits of your case.
You may have legal options under state law if your insurance provider acts in bad faith. North Carolina requires insurance companies to operate in good faith by properly investigating your case and abiding by other terms outlined in the policy. Providers may act in bad faith when they run afoul of state law, such as by providing intentionally deceptive information, or by refusing to make payments on a valid claim.
The Disability Claims Process
Your insurance policy, and applicable laws, determine the claims and appeals process requirements, regardless of whether you have a group or individual policy. However, claims for disability benefits require evidence and paperwork. The following types of evidence could factor into your case:
- Hospital records
- Physician statements
- Pharmacy records
- Financial records
- Claim forms
- An accident report
You should speak with an attorney if you have any doubts about evidence or paperwork requirements.
Additionally, some insurers require policyholders to undergo a functional capacity evaluation (FCE). An FCE, which may be conducted by a qualified medical professional, determines your impairment or limitations.
The Appeals Process
If you receive a denial, then you can opt to begin the appeals process. For an ERISA policy claim, you have 180 days (6 months) to gather additional evidence of your disability and file an appeal.
During this time, you can introduce new evidence that you did not include in your initial claim. You may only have up to 60 days to appeal if you have an individual policy.
Filing a Lawsuit
There are occasions where it is necessary to file a lawsuit against a disability insurance provider. The process for filing a lawsuit against an insurance company depends on your policy. If you have an ERISA policy, then you must exhaust your appeal options before you can file a lawsuit in federal court. Lawsuits go before a judge, not a jury, with ERISA claims. The judge decides the outcome of your case by reviewing the relevant evidence and factors specific to your claim.
You could potentially file a lawsuit against the insurance company in state court if you have an individual policy. If you cannot resolve your case through a settlement with the insurance company, then it may be necessary to file a lawsuit.
Depending on the outcome of your lawsuit, it may be possible to recover your benefits in addition to damages you suffered. Your case could also go before a jury if you are unable to reach a settlement with the insurance company. These are not legal options that ERISA policyholders can access.
VA Disability in North Carolina
Disabled veterans may be able to take advantage of state and federal resources. Eligible veterans can obtain disability benefits for certain types of injuries and/or illnesses through the VA. To demonstrate eligibility for benefits, you must:
- Have a physician diagnose an existing medication condition that resulted in a qualifying disability;
- Demonstrate that your injury or illness occurred as a result of your service.
There could be other requirements specific to your case. Much like private insurance claims, you need to provide extensive documentation of your disability. Medical records, service records, financial documents, discharge papers and testimony may factor into your case.
VA State Resources in North Carolina
For this reason, you should reach out to state or federal organizations for help with your claim. VA resources in North Carolina include:
Appealing a VA Disability Claim Denial
If your VA disability compensation claim was denied, we recommend speaking to an experienced disability lawyer at our firm. At Tucker Law Group, we are nationally recognized for our ability to fight for our clients. Our lawyers can help with the following:
- Gathering evidence for your appeal
- Filing your Notice of Disagreement (NOD)
- Filing your appeal
- Monitoring your VA disability claim
- Representing you during proceedings
Cities We Serve in North Carolina
Contact Our North Carolina Disability Lawyers
Tucker Law Group is a disability law firm that provides representation for claimants across the country. If you need help recovering disability insurance benefits or filing an appeal for your VA claim, we encourage you to contact us to discuss your next steps. You should not have to suffer due to the negligent actions of an insurance company or confusing process involved with filing a VA claim. Our disability attorneys in North Carolina can help you determine your best legal options.