Most of us don’t expect to ever become disabled. Yet the chances are good that at some point in your life, you may experience a temporary or longer disability. In fact, one study shows that 1 in 4 Americans will become disabled in their lifetimes.
Long-term (LTD) or short-term disability (STD) insurance from an insurance company like Anthem can provide financial stability if you cannot work due to a disability. However, getting approved for disability benefits through Anthem can be challenging. If you received a disability claim denial from Anthem, we can help you file an appeal.
At Bross & Frankel, our New Jersey disability lawyers are dedicated to helping people with disabilities get the benefits that they need. We offer free claim reviews for all prospective clients. To learn more or to schedule a consultation with a member of our legal team, reach out to our law offices.
About Anthem Disability Insurance
Anthem is an American insurance company that is one of the largest providers of health insurance in the United States. In addition to medical coverage, Anthem also offers disability insurance, typically through group plans offered by employers.
Anthem is a massive corporation that includes a number of subsidiaries, including Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Empire Blue Cross BlueShield, and Anthem Life. It also operates under a number of different names in states across the country.
Anthem offers two primary disability products: short-term disability and long-term disability. Both types of policies provide financial benefits to policyholders in the event that they are unable to work due to a disability. As the names imply, short-term policies cover temporary disabilities, such as recovery from surgery, while long-term policies provide benefits for disabilities that may last for years or even be permanent.
Many disability policies are offered through an employer group benefits plan. These policies are governed by the federal Employee Retirement Income Security Act (ERISA); this law tends to heavily favor insurance companies over policyholders. If a person buys an Anthem disability policy independently, then their claim will be governed by state insurance laws.
STD policies usually provide a weekly cash benefit that is based on a percentage of the insured’s weekly income. Generally, you will have to wait 1 to 2 weeks (the elimination period) before you can apply for short-term disability benefits. Most short-term policies will pay for 3 to 6 months of disability.
LTD policies provide a monthly benefit based on a percentage of the insured’s monthly income. Anthem policies usually replace 60 to 66% of an individual’s income. The waiting period for filing an LTD disability claim is usually 90 to 100 days. A person may receive long-term disability benefits for years, or even through retirement age, depending on the policy selected.
Why Anthem Denies Disability Claims
When applying for disability benefits through Anthem, an individual must prove that they are disabled under the policy’s definition and that their disability prevents them from working. If Anthem finds that you are not disabled or that you are able to work, it will likely deny your claim.
People pay for disability insurance because they want the assurance of knowing that they will be protected if they cannot work because of a medical or mental health condition. Unfortunately, insurers like Anthem often make it difficult to actually get their disability claim approved.
Anthem Blue Cross may deny disability claims for any number of reasons, such as a minor paperwork error or because they determine that you are seeking benefits for a pre-existing condition. They often deny claims based on insufficient medical evidence, or because their own review of your medical evidence led them to conclude that you aren’t actually disabled. They may also perform an analysis like a functional capacity evaluation (FCE) and use that to argue that you are able to work.
In some cases, Anthem drags out the process, delaying your claim with endless requests for additional medical records or another form. This can be incredibly frustrating, particularly as you are simultaneously dealing with a medical condition. If they ultimately send you a denial letter, then you have a limited period of time to file an appeal.
What Can You Do After Anthem Denies Your Disability Claim?
If you receive a denial letter from Anthem Blue Cross for your disability claim, it is critical that you read it carefully. It will contain important information, such as:
- The reason for the denial
- The standards used to decide your claim
- The appeals process
- The timeline to file an appeal
Typically, you will need to file an administrative appeal with Anthem, often within 180 days of the claim denial. If Anthem Blue Cross denies this initial appeal, then you may need to file a second appeal. You must exhaust the internal appeals process before you can file a lawsuit against the company.
After receiving a final denial from Anthem, you can file a lawsuit in federal court (for policies covered by ERISA) or state court (for policies that were purchased independently). Importantly, you can typically only use evidence that was submitted as part of your initial disability application and any appeal letters that you filed. For this reason, it is vital that you build a strong record both when applying for disability benefits and throughout the appeals process.
There are several different kinds of evidence that are helpful in appealing a disability denial from Anthem Blue Cross. This includes medical evidence, including test results and treatment notes. You may also submit:
- A report from a vocational expert that analyzes your ability to perform your job duties in light of your disability
- A report from your treating physician about your symptoms and how they affect your ability to perform daily tasks and work
- Statements from friends, family, and coworkers about how your disability affects your ability to work
Your New Jersey long-term disability lawyer can help you build a record that will support your initial disability insurance claim and any appeal. They can also carefully read your insurance policy to determine Anthem’s definition of disability and other policy terms. This step is crucial, as the definition of disability is a key factor that insurance carriers use to deny claims.
The appeal process can be complicated and relies on an understanding of the laws that govern your policy. You must also meet all deadlines, or else your claim might be denied outright. In New Jersey, our disability attorneys can help you with each step, from filing a disability claim to appealing a denial of benefits.
Anthem Disability Claim Denied? Contact Bross & Frankel
When you cannot work because of a disability, you need disability benefits to be able to pay your bills. Too often, insurance carriers like Anthem Blue Cross make it incredibly difficult to get benefits. If you find yourself in this situation, our law firm can help.
From our law offices in Cherry Hill, Bross & Frankel advocates for clients in New Jersey and Pennsylvania. We help people with all kinds of disability claims, including Social Security disability, short and long-term disability, and disability benefits for veterans. To learn more or to schedule a free claim review with a New Jersey long-term disability attorney, give us a call at 856-795-8880 or fill out our online contact form.
Can I Appeal a Denial of Short-Term Disability Benefits?
Yes. While it is more common for a long-term disability claim to be denied, insurers like Anthem Blue Cross may also deny a claim for short-term disability benefits. This may happen for a variety of reasons, such as having a pre-existing condition, not submitting enough medical evidence, or because you haven’t been working long enough (known as the waiting period).
Once you receive a denial, you must read it carefully to find out the appeal process. You can then submit an appeal letter with any additional documentation. For help with a disability appeal, contact Bross & Frankel to talk to a New Jersey short-term disability lawyer.
Do I Need a Lawyer to Appeal an Anthem Disability Claim Denial?
You are not required to hire an attorney to file an administrative appeal with Anthem. However, it is a good idea to have a disability lawyer for this process – particularly because if you need to file a lawsuit, you will be limited to the records that were already submitted. Your lawyer can help you understand your rights, prepare an appeal, gather additional evidence, and file a lawsuit if necessary.
Insurance laws are incredibly complex, and insurance policies are known for having incredibly dense language. While it may be possible to handle an internal appeal on your own, it may lead to you not getting the benefits that you deserve. In New Jersey, call Bross & Frankel to talk to our disability attorneys about your claim.
Will Anthem Use a Private Investigator for My Claim?
It is possible. Insurance companies like Anthem Blue Cross are known to aggressively investigate long-term disability claims. They may scour your social media, follow you, and/or take pictures and videos of you as you go about your daily life – all to prove that you aren’t really disabled. This can often feel incredibly invasive.
A New Jersey long-term disability lawyer can advise you of your rights and help you understand how you can protect yourself throughout this process. Reach out to Bross & Frankel today to schedule a free claim review with a member of our legal team.
Rich Frankel is the managing partner of Bross & Frankel. He is a member of the New Jersey and Pennsylvania bars. He has focused exclusively on disability and social security benefits since 2005.
Mr. Frankel joined what is now Bross & Frankel after having watched his father struggle with disability, fighting a lengthy illness. Mr. Frankel founded the firm’s veteran’s law practice and substantially grew the social security disability practice, focusing Bross & Frankel’s ability to fight for all of the disability benefits available to his clients.
Mr. Frankel additionally fights for clients in court, obtaining frequent victories in Social Security appeals and against insurance companies in Federal court.