AIG, known to many as the American General, offers long term disability insurance policies to companies to pass along to their employees. But when it comes time to submit a long term disability claim to AIG, you may be wondering where to begin. Navigating the ins and outs of a long term disability claim can be complicated, but you don’t have to do it alone. Learn more about what claimants can expect when filing an AIG long term disability claim, as well as how the legal team at Dell & Schaefer can assist with the disability claim process.

We can quickly let you know if we think you have a valuable claim against AIG. Many of these claims are resolved through a lump sum settlement, which can help provide claimants with an instant source of income during an otherwise uncertain time.

GREGORY DELL: Hi, am attorney Gregory Dell. And today, I’m here with attorney, Stephen Jessup. And we’re going to talk about AIG, known as the American General life insurance company.

And, Steve, they are a gigantic insurance company. We know from years ago that the government bailed them out when they almost went bankrupt. And they came back with a vengeance, which was great.

But disability insurance is not a big chunk of their business. They’re a big worker’s comp insurer, life insurer, property and casualty insurer. But they do do some disability insurance claims. And we’ve handled a fair amount over the years. But it’s one of the smaller players in the industry for sure.

But more so, because they’re not marketing it heavily. But so let’s talk about in this video what someone could expect with an AIG claim, or the United States of America life insurance company out of New York if you have a policy with New York. So let’s start with first the types of policies that we see from AIG.

STEPHEN JESSUP: Yeah, the majority of the policies we’re going to see under disability are an employer provided group disability policy. So you are going to fall under federal statute under ERISA. And so that will come with a general sense of what the rules are, how claims need to be approached, documented, looked at, and you know, if there’s denials, the steps you have before you have legal recourse with them.

Some more likely, you’ve gotten this plan through an employer. But like you said, they’re not one of the larger players. So the policies can be unique, and they also offer policies for very small businesses. So they also fit in some other niches that some of the bigger insurance companies won’t.

The Five Most Important Things to Know When Filing an AIG Disability Benefit Claim

GREGORY DELL: And the reason is, is that insurance companies sell disability insurance like a product, like they sell life insurance or critical health insurance and things like that. So when they go to a company and the agent’s selling worker’s comp, they say, how about we also offer disability insurance. So when it comes to the AIG disability insurance and a person is ready to file a claim, what are things– let’s talk about the five most important things that a person should know when they’re going to file their AIG claim?

STEPHEN JESSUP: I think first and foremost– this seems like common sense. But it’s really not– it’s important to know how long you’ve been covered under the policy. Because if you’ve been covering the policy for less than a year, you do run into a risk of a pre-existing condition. So I think it’s also important to know what your coverage is and how long you’ve been covered under that policy to avoid those surprises. So first and foremost, that.

From a substantive standpoint, if you’re not worried about pre-existing condition issues under the policy, then it’s really about understanding how your policy is going to review for your occupation. Is it a known occupation? Are they going to look at like, your job that you perform as it’s performed in the national economy? Or is it this idea of any occupation?

And then medical conditions law times are limited under these policies. 24-month-old caps on mental health. So understanding your policy. And that’s where getting a copy and having a lawyer look at it can help greatly if you’re thinking about filing and helping direct you in the right way of establishing the claim that’s going to give you the best chances of success.

And then from there, it’s medical. You know, what are your medical records saying? What have you been discussing with your doctors? Is it properly documenting how your condition is preventing you from working?

So those are kind of the global set of things you’re going to look at when determining hey, do I have a case I can file? Am I even covered under this policy? You know, just knowing– because your employer– you know, they’ll tell you have these benefits, but they don’t necessarily have really any idea how the policy’s going to work and the laws that are going to govern it.

GREGORY DELL: OK, a lot of the AIG policies that I’ve seen have 180-day elimination period. I want you to first talk about, what does that mean?

STEPHEN JESSUP: Elimination period just means that’s a period of time that you were not going to be paid benefits, so 180 days, six months. So you have to be out of work for six months before that long-term disability policy is going to kick in. Now, it could be that the employer has short-term coverage that may be self funded through them. Sometimes these are third-party administrative. But if you only have long-term disability coverage, you may have to be without pay, not working for six months before any of the benefits are going to kick in.

GREGORY DELL: OK, now, a lot of employers will lay an employee off after missing work for 90 days. A lot of people call and say, I’m going to get terminated at 90 days or 120 days since I last worked. Do I still have the ability to apply for long-term disability coverage?

STEPHEN JESSUP: As long as you meet their definition of an eligible employee, you know, that you are employed at the time of the filing, then the coverage is intact under a pure group disability plan of this nature. But you know, we get calls sometimes– hey, I’m about to be laid off. I’m going to get laid off in x amount of time. I’m thinking about filing.

Don’t wait to the last minute. You know, you need to make sure everything’s in order. Plus, it takes away an insurance company’s ability to argue that well, you’re only filing for disability because you’re about to get laid off. So if you have concerns that your condition is preventing you from working, causing issues that may get you written up or terminated, whatever the case may be, it’s really wise to contact an attorney at that point to understand what you can do to protect yourself and protect your rights and to have the coverage.

Steps That Must be Taken if Your AIG Disability Benefit Claim is Denied and Appeal Tips

GREGORY DELL: OK, we know AIG writes some group insurance policies in the sense for organizations. And usually those policies are exempt from ERISA. And we have videos where we discuss what does it mean if the policy is governed by ERISA.

But the majority of the AIG policies are provided by an employer and they are governed by ERISA. And the ERISA regulations, the teeth of that law really digs in when a person has to file an appeal because their claim has been denied. Can you talk about the process that a person with an AIG policy provided by their employer will have to follow if their claim has been denied?

STEPHEN JESSUP: So if claim’s denied under the law, ERISA, you have to file mandatory administrative appeal before a lawsuit can be brought. The law says you have 180 days from the date of the denial to submit your appeal. There is only one level of mandatory appeal. And this becomes very important, because when you look long-term perspective of what happens in court, the appeal is at this point going to be the most important document, because it will be your last opportunity to be able to provide any information that a court could consider in the event they denied the appeal.

So if you have physical, medical conditions, you know, any objective diagnostic test, maybe functional capacity testing, cognitive problems, neuropsychological testing, you want to have everything in the appeal. The appeal then goes back to AIG. They get a chance–

GREGORY DELL: Wait, so the same company that denied the claim is reviewing the claim?

STEPHEN JESSUP: The same company, which you know, there’s obviously conflict of interest. And it’s the same company that’s going to pay your benefit is going to look at it. But the built-in protection afforded by the law is it’s going to go to a new claims representative and new doctors and vocational people who had nothing to do with the review of your file– is going to look at it to see if the initial decision was right.

Most people say, why the heck would they ever approve the benefit? But you can win your appeal, because it always goes back to your medical documentation. Now in the event that the appeals denied and you find yourself in court, you understand why that appeal is so important.

After that final denial, no new information would be brought in for a judge to consider. So to understand why this area of the law is going to be so strange and different for you is what happens in court. There are no jury trials.

The only decider of facts will be a federal judge. You won’t testify. Your doctors won’t testify. And the court is only going to look at what’s in your claim filed, the administrative record. And what that is, is all the information you’ve submitted or AIS has created up to the time of that final denial.

As of that date, anything could happen. God forbid, you get in a severe car accident, you’re diagnosed with cancer. A judge can’t consider that. A judge can only consider this snippet in time.

And the general you know, default standard of review is known as arbitrary and capricious, which you know, we have lots of stuff on that and in litigation. But essentially what that is, is you have to prove that you were disabled. And that AIG essentially didn’t have a reasonable basis to deny your claim. It’s a very low threshold.

So knowing that that’s what you’re walking into court, that’s why if there is that denial, your appeal is, for all intents and purposes your trial argument. It’s everything you’re going to have. And there is an art to writing those that we’ve discussed multiple times.

GREGORY DELL: Well, that’s what I wanted to ask you. People call and they say hey, Steve, I appreciate the free consultation you’re giving me. But why do you think I should have a lawyer to write my appeal?

STEPHEN JESSUP: Because there’s this very fine art of how you present the information. First and foremost, your documentation in the file, vocationally, medically, is always going to be the real teeth of a claim. And if you know, you argue in the file, in the appeal everything that they did wrong, or sometimes people review cases and our lawyers would argue a lot of case law on their appeals– and what they’re doing is they’re giving AIG a roadmap of what they did wrong.

So on appeal, they say well, you said, we didn’t do x, we didn’t do y, we didn’t do z. Well, we did x, y, and z now, and we still found this. It’s then hard to argue to a court that they acted unreasonable, because you told them everything they did wrong and then they rectified it. So it’s really an art of presenting the information in a way that establishes the disability without also depriving you of arguments that you can make in court later.

Creating a Custom Attending Physician Statement is a Great Tool to Help Win an AIG Appeal

GREGORY DELL: Right, and I think also that for me, when I’m doing my appeals, writing the appeal is actually not the hardest part. I find that the biggest value that we bring to a claimant is getting the additional information and sorting through what AIG is looking for. And then working with the claimant’s treating doctors or new doctors or medical experts or vocational experts or psychology experts or economical experts– all the different experts that we’ve worked with to determine what we want to put in there that a claimant who’s not involved in this type of thing would never know to obtain.

And also, the manner in which we communicate with the treating doctors– I mean, the custom attending physician statements. I mean, talk about that one thing. What is a customer attending physician statement compared to what the disability carrier asks for as proof of medical?

STEPHEN JESSUP: Well, what you’re going to get from the insurance company is usually relatively generic. Outside of if you have a mental health condition, there will be a specific questionnaire for that. But any other medical condition, whether you have a bad back, a heart condition, migraines, they’re basically it’s in the same standard form language in it. And it’s almost going to be derived towards this idea of what the Department of Labor determines work– sedentary, light, medium, heavy. And they try to pigeon hole your doctors only into those categories.

So they don’t give a lot of room for elaboration, I think. So in these custom APS’s we’re taking a look at your medical condition, how that medical condition is going to impact job functions in relation to how disability is defined. And then it allows the doctor to really elaborate and just focus on your problem, as opposed to a plethora of other things that are going to be on that form and really get to the heart of the matter.

Additionally, a lot of these forms that we see they give– say you have a physical condition. You have bad back. That’s why you can’t work. But you have a desk job.

Obviously, a bad back, sitting all days is really the worst thing you can do. And on these forms, when they’re asking doctors for restrictions, they’ll give the options. And they’ll say you know, can they do x, y, z? And it’s sedentary. It basically falls into sedentary, light, medium, whatnot.

And doctors may say, well, I don’t think this person can do that much. So I’m just going to do the lowest one, the most restrictive one, which is sedentary, not realizing the insurance company is going to say, well, they had a desk job, sedentary. It’s a denial. So they trick the doctors almost into getting a claim denied at no fault to the doctor.

GREGORY DELL: Right, the other thing I tell claimants is that when you walk in with this custom form, we make it in such a way where it’s kind of like, maybe fill in certain things about the medical condition diagnosis, which is very easy to do. But then the specific questions are kind of yes or no. They’re very targeted in the manner in which we want to take back the results of that attending physician statement and how we’re going to implement it into our appeal and how we’re going to discuss it.

And there’s questions asked in a manner where a patient can never kind of have that dialogue with the doctor. But when it’s coming from one professional to another, they know there’s a purpose and an intent behind it. And the doctor is going to feel comfortable answering that.

So you know, the other area is obviously lawsuits against AIG, which we file in federal court all over the country. And that’s the final remedy after a appeal has been denied. And that’s a process that is pretty much similar with all the companies. And that gets into the standard review as to what’s going to be applied based upon the policy language, based upon the state in which the policy was issued.

So if you have a claim that’s been denied, what we need is a copy of the denial letter. We’ll then get a copy of the entire claim file, provide a complimentary review, and let you know immediately if that’s something we can help you with. But clearly, we’ve seen hundreds of these types of disability claim denials. And we’ll be able to let you know very quickly if we think we have a case you can win, and also, what we think is a value of the claim.

Because as you know, Stephen, a lot of these cases resolved with, not necessarily the claimant getting back on claim, but getting a lump sum settlement that equals several years of disability benefits. And that’s an option considering a person has no income, might have to litigate for two or three years and needs the money now. So that’s an alternative that’s very often available and something that we’d like to discuss with you.

So whether you have a claim with AIG at any stage, whether it’s applying, denying, you’re on claim and you want help to deal with the company or you’ve been denied, feel free to give Stephen or myself a call. We’re available to help you anywhere in the country. We’re never going to charge you any fees or costs to handle your claim unless we make a recovery for you. And we welcome the opportunity to discuss your claim.

Regardless of what stage your AIG disability claim is currently in, the experienced long term disability attorneys at Dell & Schaefer can help. We won’t charge you any fees until or unless we recover a judgment or settlement for you. Get in touch with us now to schedule your FREE consultation with a member of our team.