In California, Anthem Blue Cross is offering short-term and long-term disability insurance benefits to groups with 10 to 50 employees. These new plans are in addition to the disability products that Anthem has traditionally offered to employers with 51 or more employees.
“Disability plans provide a source of income when employees can’t work,” said Mike Wozny, president of Anthem Life. “But our disability plans do more than just replace wages. We can help employees who work for small businesses in California get back to a healthy, active life and back to work quickly and safely. Our disability case managers and medical nurse care managers share clinical information and work hand in hand to help employees get healthy and return to work faster.”
Anthem Blue Cross Disability Insurance
Disability Insurance protects LTD policyholders from the loss of income resulting from an inability to work due to an accident injury or illness. Anthem typically replaces 60-66% of income and the length of time the policy pays out depends on which plan was selected. While California does have a statutory disability plan (CA SDI), the state plan only replaces 55 percent of an employee’s income for up to 52 weeks. A short-term disability plan from Anthem would offer benefits on top of the state plan, replacing an additional five to 15 percent of an employee’s salary depending on the plan purchased. Anthem’s long-term disability plan extends that coverage for more complicated and longer duration claims. Both short and long term disability plans also include valuable extras not available in the state plan and are offered on top of CA SDI.
Anthem Blue Cross Long Term Disability Attorney
Many individuals who file for LTD benefits are shocked and dismayed with the hurdles placed in front of them by Anthem Blue Cross in filing the claim. The insurance company adjuster requests more and more paperwork as part of the insurance company’s investigation into the long term disability claim. Just when you think you’ve filled out the last form, you are given yet another one to fill out.
Your doctor may begin to get annoyed with Anthem Blue Cross phone calls to the doctor’s office and numerous requests for the doctor to also fill out paperwork. Then, after the investigation into the claim is finally finished, Anthem Blue Cross denies the claim.
Policyholders call us very upset when they are denied the very benefits they thought would be there to protect them when they became unable to work due to an injury or illness. Most are upset or downright angry at long term disability insurance companies for their delay tactics and denials. That’s why it is important to have an experienced long term disability attorney assist you in explaining to you the reasons for the insurance company’s denial, and what you can do to fight back and win your claim.
At the Ortiz Law Firm, we know how difficult it can be to deal with all the paperwork associated with filing a long term disability claim and proving the loss. You have enough to deal with in treating your injury or illness. We also know how important these benefits are to you and your family when you are unable to work and earn an income. Let us take on the burden of fighting the insurance company. With experience in dealing with insurance companies, our Anthem Blue Cross long term disability lawyer has the skills and knowledge needed to help you understand your rights under your policy in order to pursue the benefits you deserve.
Definition of “Disability” in a Anthem Blue Cross Insurance Policy
The term “Disability” is defined in each individual policy. Your definition may be different than the sample one below. You should always check your own policy to determine how the insurance company defines the term “disability” in your long-term disability claim. However, to give some insight into how Anthem Blue Cross may define disability, this is how it defined the term in a past policy:
Disabled and Disability mean during the Elimination Period and the next 36 months
because of Your Injury or Illness, all of the following are true:
- You are unable to do the Material and Substantial Duties of Your Own
- You are receiving Regular Care from a Physician for that Injury or Illness;
- Your Disability Work Earnings, if any, are less than or equal to 80% of Your
Indexed Monthly Earnings.
Thereafter, Disabled and Disability mean because of Your Injury or Illness all of the
following are true:
- You are unable to do the duties of any Gainful Occupation for which You are
or may become reasonably qualified by education, training, or experience; and
- You are receiving Regular Care from a Physician for that Injury or Illness;
- Your Disability Work Earnings, if any, are less than or equal to 60% of Your Indexed Monthly Earnings.
Filing a Successful Appeal When Your Anthem Blue Cross LTD Claim Has Been Denied
In the end, insurance companies exist to make money. They do so by collecting more in premiums than they pay in claims. The fewer payouts they make on claims, the more profits they keep for shareholders. If you understand this basic premise, you will have a greater understanding of why even the best-prepared disability claims can be denied. It is not personal to you. If you receive a denial letter from Anthem Blue Cross insurance company in response to your application for benefits, do not despair and give up. You have the right to file on ore more appeals directly with Anthem Blue Cross through its internal appeals review process. After you have “exhausted” your appeals, you have the right to file an ERISA lawsuit.
Note: if you have an individual policy you purchased on your own (outside of a group plan), or if you are a government employee or member of a church plan, you may be exempt from ERISA regulations and have the right to file your lawsuit in state court, which affords greater protection in disability claims to you, the consumer, than an ERISA claim in federal court. This is why it is important to hire an attorney to explain your legal options to you.
Improve Your Chances by Consulting with an Experienced LTD Attorney
When filing a claim for LTD benefits or appealing a denial under an Anthem Blue Cross disability plan, the guidance of an experienced Anthem Blue Cross disability lawyer can be extremely helpful and improve your chances of obtaining the benefits you are entitled to receive.
Ortiz Law Firm who is experienced in Anthem Blue Cross LTD claims understands the difficulties pursuing an Anthem Blue Cross claim for LTD benefits. The Ortiz Law Firm has helped hundreds of clients in long term disability claims. They represent clients primarily during the administrative review appeal process, and in state and federal court when a lawsuit must be filed.
Legal Help in Getting Your Anthem Blue Cross Claim Approved
When filing an application or appealing a denied claim for long term disability benefits under an Anthem Blue Cross plan, it can be helpful to have the assistance of an experienced lawyer. We work closely with our clients throughout each stage in the LTD claims process, including:
- Gathering all medical records and other documents to support the claim;
- Obtaining opinion evidence from doctors and perhaps vocational experts;
- Organizing your financial records;
- Reviewing and answering all questions on the disability claim application; and/or
- Filing your claim and/or appeal in the manner that maximizes its chance of approval.
Unfortunately, even the most severe disabilities and the best-prepared claims may be denied by Anthem Blue Cross. In the event that you receive notice of a denied claim in a denial letter, you should be aware that you have the right to file an appeal. In the event that you have exhausted your appeals with the insurance company, you may have the right to file a lawsuit under the ERISA Act. The Ortiz Law Firm has experienced disability attorneys and can help you obtain the benefits you deserve. Our disability law firm offers detailed advice on the many issues related to the claims and appeals process, including:
- Helping you understand the reasons for your denial;
- Acquiring additional evidence, including medical records and other documents in support of the appeal;
- Completing the appeals paperwork;
- Filing your appeal within the time limits allowed;
- When necessary, filing an ERISA lawsuit in Federal Court; and/or
- Briefing your case for consideration by a federal judge during the ERISA lawsuit.
You don’t have to face your battle against Anthem Blue Cross alone. The Ortiz Law Firm is here to help in the appeal process.
If your LTD claim has been wrongfully denied or terminated, contact our office today at 850-308-7833 to schedule a free consultation to discuss your case with an experienced Anthem Blue Cross disability claims lawyer.