Receiving a letter denying your claim for long term disability benefits can be a huge blow, especially if your condition is preventing you from earning an income or taking part in hobbies and activities you once enjoyed. What options do you have if Principal Financial Group has denied your claim for long term disability insurance benefits, and where should you go from here? Read on to learn more about the factors to consider when deciding how to proceed, as well as how the legal team at Dell & Schaefer can help you obtain the long term disability income benefits you deserve.
GREG DELL: Hi, I’m Greg Dell with attorneys Dell and Schaefer. And I’m joined today by attorney Stephen Jessup. And we’re going to talk about Principal long-term disability insurance company and specifically what your options are if your long-term disability claims have been denied. And so, Stephen, when we talk about Principal, they’re one of the smaller long-term disability companies that happens to offer group as well as individual disability insurance. And we’ll get into in a minute what that means.
But in this video, this is really geared towards the person who’s either been denied or they’re worried that they’re about to be denied, and they want to know what are my options and basically how can our law firm help them to get their benefits reinstated for them– or approved if they’ve never been approved. So what’s the first thing that you need to consider when someone calls you and says, “I have a Principal long-term disability policy and my benefits have been denied”?
STEPHEN JESSUP: Well, the first thing I always want to know, like you alluded to– is it a employer-provided group disability policy or is it an individual policy you purchased on your own through an agent? Because that’s going to kind of dictate how things are going to happen or progress legally and what your options will be. So that’s the first thing I’m always looking for when someone calls.
GREG DELL: And why does that matter?
Your Options Vary Based on the Type of Policy You Have
STEPHEN JESSUP: It’s going to be about really with what your right term requirements are. If it’s an employer-provided policy, you have a mandatory administrative appeal, meaning you write a long document explaining why you disagree, provide new information. That goes back to Principal for them to do a review. Whereas if it is a private policy, an individual policy, you do not have to go through that administrative appeal process. They will give you the option to, but you have no legal duty. If you wanted to, you go straight into law lawsuit at that point.
And then, realistically, once it gets to court, the legal standards for the two types of policies are completely different. So that’s why knowing what type of policy it is will kind of dictate where you’re going to look for things and how you’re going to try to track the case.
GREG DELL: OK. So you’re dealing with group governed by ERISA and individual, which people may have bought specifically from an insurance agent. And for those people, they could possibly just go right to lawsuit?
STEPHEN JESSUP: Correct.
GREG DELL: So it’s basically appeal or lawsuit depending upon what it is. The other thing I always like to talk about in these videos– because we handle claims for obviously not just Principal but over 30 different disability carriers that we file the claims against– what’s your take when someone’s calling you on Principal insurance company as opposed to the 30 other companies that we deal with?
STEPHEN JESSUP: You know, Principal, again, they’re a big company, but they’re not one of the biggest that we’ll see commonly. You’ll see denials from Cigna, Prudential, Hartford that are just rubber-stamped, real quick, simple reviews. Principal, since they do have the individual policies that they do and the way that they manage those, that kind of also goes into the group side of it.
Principal Performs Detailed Reviews of Disability Claims
So they do very thorough reviews. It’s not like they’re just going to have a nurse look at something and say, “Oh, this one record says someone’s feeling better. You’re denied. Go back.” They’re going to really take their time to do the reviews, whether internal medical reviews, external. They’re going to do a lot more. So if a claim denial’s coming, they’ve done their legwork early on, as opposed to waiting for the appeal to do it.
GREG DELL: All right, so whether someone has a group ERISA or an individual, the first steps that you’re going to take when trying to determine the benefit denial options for a claimant, what is that first step going to be? What are the important documents that you first need to see to evaluate what you’re going to do?
STEPHEN JESSUP: Denial letter, obviously. That’s going to kind of set forth everything that they did. And a lot of times, we’ve seen enough of them that where someone who’s received their own denial letter, they hone in on various aspects. But we are used to seeing them, so we know there’s a lot more hidden gems in there that can set the stage for what we’re going to do. So the denial letter, unequivocally, we need that.
The policy, not everyone has the policy. So a lot of times, especially on the group side of things, the ERISA policies, they will put a lot of definitions in there. But ideally, the denial letter is non-negotiable. We need that and then the policy, because that’s also going to dictate are they applying the terms and conditions appropriately and then also what the future rights and benefits are going to be based on what the language is in your policy.
GREG DELL: And then, again, if it’s ERISA, you’re going to have to file an appeal. And so we’ll talk about that first, but I often find at Principal, even if it’s not ERISA, they’re still willing to give you a copy of the claim file less any privileged communications or documents. And in some cases, we may explore doing an appeal–
STEPHEN JESSUP: Correct.
GREG DELL: –and not just jumping the lawsuit, as opposed to just filing a lawsuit right away because of the fact that it’s very timely to file a lawsuit. And if there is a path to get benefits reinstated quicker, you should always explore that. The other thing about doing an appeal in a non-ERISA claim is the fact that your claim may not be ready for a lawsuit.
STEPHEN JESSUP: Correct.
GREG DELL: And so there’s an opportunity to improve the claim. And especially, with our experience, we may see things that, hey, if you add this, whether they reverse it or not, you’re going to be in a much better position to get your benefits approved. So let’s step back, though, and talk about the ERISA appeal. Talk for a minute about the requirement to do that and what the claim file is and then the steps you take to pursue that appeal.
STEPHEN JESSUP: Yeah, you have that requirement. You have 180 days from the date of denial to submit your appeal. Generally speaking then, too, a good thing to do– first thing we do when we’re hired– is request a copy of the claim file, put in letter of representation, get the claim file.
The claim file is everything they have on you, whether that they created or you submitted as part of your claim. They have to turn that over to you. All those medical reviews they use to deny, all that stuff. So they have 30 days under the law to get that to you, even though most of the time they’ll be in advance to that. It’s not too often they take the whole 30 days or go beyond that. But then during that time, also, we’ll be requesting medical records, things like that.
But the claim file will give you everything. So that’s one– ERISA– in our videos, we talk about there’s a lot of cons to it. That’s one of the pros. There’s nothing hidden from your view to be able to address and argue in your appeal. So that’s one of the first things that we’re always going to do– just get that.
GREG DELL: And then what are the key documents? And I know we have and I encourage people to watch– we’ve done a separate video on tips for filing a Principal disability appeal. And we’ve also done a separate video about lawsuits against Principal. But can you just touch on what are the key documents that you’re looking for in the claim file?
STEPHEN JESSUP: Medical reviews, vocational reviews– so any employability analysis– and then any surveillance, any type of background investigations, whether it be social media, actual video surveillance. Those are the things I’m going to pull first, because that’s usually what the claims manager is going to use to deny the claim.
And then it’s a matter of then trying to dissect their internal notes that they keep, which can be very confusing. But then you get a glimpse at the communication internally in the company as they’re reviewing things. So that’s what I’m going to be pulling from the claim file first.
You’ll Likely Need 180 Days to Submit a Strong Appeal
GREG DELL: And then you mentioned there was 180 days to file an appeal. Why? 180 days seems like a long time. And I often find that that time is needed. Can you explain why you really truly need the full amount of time to do a good appeal?
STEPHEN JESSUP: Yes, six months when you don’t have money coming in is a long time. But on these ERISA cases you get one shot. So say you have potentially 25 years of benefits into the future, if you rush your appeal, you could miss out on all those. So that 180 days, if you’re only going to get one opportunity to submit your appeal.
And if they deny the appeal, your claim file, it’ll close. So after that point, you file a lawsuit then, no new information comes in. Your opportunity to argue information to a judge has stopped then. So you want to make sure everything that you possibly can get in that’s going to support you is there.
Some of the hardest cases that we will get is when someone– they get a denial. They say I already appealed it. They denied my appeal. Let’s say OK, you get all the information. You see their appeal, they wrote it the day of, handwritten. I disagree, I want you to review. They review it. They uphold the denial. And there’s no new information. Now that person is stuck. So the rush to appeal can really bite you.
Not to mention, even if you submit your appeal, Principal is going to have 45 days to do a review, a possible 45 day extension. You’re looking at three months if you submit it same day. So making sure you have everything with the appeal that you present to them actually can also make the review process quicker, because they’re not going to ask for additional stuff or request some information from you. So you want to make use of that, because you have to play the long game with them. It is really a long-term battle with them.
GREG DELL: And the world of ERISA disability claims where we specialize in doing these types of long-term disability appeals is an anomaly, because the letter is misleading in the denial letter, where it says, “You have the right to appeal. And you should request one, and someone else may look at it.” And people think, OK, I’m just going to get a second opinion. You didn’t like it, but I’ll give it to someone else.
And they’re not clear about what needs to be in there and the magnitude of the fact that if you do it on your own and you don’t get everything and anything in there, then when you call us for the lawsuit– which all the time we get people who call us who we don’t do their appeal– we’re married to what they did. Even if the day they call and say, “I got denied yesterday and guess what, today came the approval for Social Security disability,” or “Today I got a positive MRI,” or some kind of additional evidence, it’s not going to be considered.
It’s not going to be part of the record. It’s not going to be in the lawsuit no matter how good your lawyer is. It’s just not coming in as additional evidence, because the law cuts it off from the moment they made a final decision.
And there’s no other area of law that really does that, because in most types of disability type cases, when you’re bringing a claim against an insurance company and you go to court, you get your day in court. But here in the ERISA disability world, your day in court is a review of what was already submitted up until the point in time they make that decision. And that review happens 18 months to two years later by a judge who’s looking back at just a pile of papers–
STEPHEN JESSUP: A snippet in time.
GREG DELL: –with no testimony or no nothing. So I encourage you to watch our Principal appeal disability video where you can get a lot of tips about the appeal process. And since we’re talking about all the benefit denial options, of course, if the appeal’s denied, then your remedy with ERISA is to go ahead and file a lawsuit, which has to be filed in federal court.
And basically, our law firm can file that in almost any federal court across the country where Principal at least does business. And as far as I know, they’re doing business in all 50 states. So we’d have the ability to represent you in all 50 states for a lawsuit.
The ERISA lawsuit– I touched on just a minute ago, saying it’s basically a trial on the papers– there’s no testimony. There’s basically no discovery. It’s a process that usually you’re not going to get to a briefing of a final decision until about a year, give or take. And then the judges are taking at least six months to make a decision.
STEPHEN JESSUP: Yeah, it takes a long time.
GREG DELL: So that’s an 18-month process. And again, watch our Principal disability video for details on that. And obviously, call us for a free consultation if you’ve been denied. And we’ll review your denial letter and get on the phone, spend as much time as you want and go through all of your options and let you know right away how we can help you with the ERISA denial.
But I want to shift gears real quick and touch on the private Principal denial, because it’s a little bit a different animal. And we mentioned earlier that we could do an appeal. How does that process shake out in the private world versus the ERISA world, because it’s quite different?
It’s Often a Good Idea to Submit a Strategic Appeal Before Suing
STEPHEN JESSUP: Yeah, and I think you touched upon something that’s really important. I say if there is an opportunity for an appeal and there are things missing, do it, because you don’t want to go and file a lawsuit when your case isn’t prepped, because now you’re against the time crunch and all those things and it’s expensive. Private litigation in these policies can become very expensive.
So I’ve done more than my fair share of individual Principal products and doing appeals and getting those overturned. And it can be a much quicker way to get the client to the money, because there may be things you’re just lacking. Principal can say, “I’m not seeing X, Y, and Z. We don’t understand this.” So doing an appeal, getting all the medicals, and making the arguments.
And on those individual policies, what is nice it’s– generally speaking, it’s all pure own-occupation, what that person’s occupational duties are. So you can really kind of hone in and focus the correlation in the nexus between the condition and it. So the appeal– a lot of times people contact us. They’re mad. They want to sue. But sometimes cooler heads have to prevail. And understand that you can save time and a lot of money going through an appeal with them.
GREG DELL: Right, because if you have to file a lawsuit, that could be in state court, could be in federal court. There’s a bunch of factors with that that need to be determined. The other thing is that litigation is costly like you said. Not a cost necessarily for the claimant that they’re risking their money, because we handle all of those cases on a contingency fee basis, where we’re absorbing all of the costs so that if the claimant loses they have no out of pockets.
If they do win, then they’d have to reimburse those costs. And many of those costs can be paid by the courts as an award of expenses. Some are allowed, and some are not allowed. So at the end you can get those back. But there’s no risk in terms of worrying about that expense. It’s more the time and the extensive discovery, the interrogatories, the request for production, the request for admissions, the depositions.
STEPHEN JESSUP: Yeah, if you thought they were in your life doing the claims handling– And there, not only you but family, associates, all that stuff are going to be subject to questioning.
GREG DELL: And that’s your typical run of the mill litigation. So with all of that, still you can expect if you do file a lawsuit that possibly within six to nine months you could be at a mediation in a private disability case and also in the ERISA disability lawsuits as well. And that’s an opportunity where I would say that 75% of cases resolve with a lump sum type settlement, which I’ll touch on that, which basically means that the end resolution of a lot of these cases is the fact that you get bought out of your policy.
So if your policy pays you for another 10 years, they may offer you two years. They may offer you eight years. They may offer you five years, and say, “We’re paying you one time, and we’re done with you. And go do what you’re going to do. We’re not agreeing you’re disabled. We’re not agreeing you’re not disabled. We’re just buying you out. Take the money. And we have a divorce, and we never talk to each other again.”
The Vast Majority of Litigated Principal Disability Denial Lawsuits End in a Lump-Sum Settlement
And that’s the way that 99% of these cases end up getting resolved, whether it’s at a mediation or if it’s before trial or after trial– but not just disability cases, all lawsuits have like a 99% some kind of resolution type agreement without having to go to verdict. So those are all the options that we can talk about. And also we can tell you about the value of a case, because we’ve handled so many of these, we basically know best case scenario, worst case scenario, here’s what Principal’s going to offer you.
And since we do handle these cases on a contingency, we are selective in the cases that we accept, because we’re taking on a lot of risk in terms of representing a claim to try to prove a case. And we have to investigate a case and make a determination as to whether or not we think we can win, because we’re not going to get paid unless the claimant’s going to get paid.
And that makes the claimants feel really comfortable, because they know we’re vested in their claim, in terms of what’s going on. So that’s an important factor. As opposed to a claimant possibly paying a lawyer for hundreds of hours who the lawyer doesn’t have an incentive one way or the other, which I don’t like, which is why we don’t offer that business model. We want to be vested in the claim, believe in the claim, and do everything we can so that we’re both getting paid at the end of the day.
So no matter where you live in the country, we encourage you to contact either Stephen or myself or any of our disability lawyers to discuss your long-term disability denial with Principal. What we’ll do is we’ll request a copy of your denial letter. We’ll immediately provide you with a free initial consultation, which we’ll do via telephone. And we’re going to let you know immediately if we think we can help you.
The other thing we encourage you to do is spend a little bit of time on our website. Search up the cases that we’ve handled against Principal and lawsuit summaries that we’ve written. Also spend some time educating yourself on our website by looking up your occupation, specifically looking up Principal obviously, and looking up your medical condition. You’re going to find that you’re going to very quickly become educated in the long-term disability process.
And Stephen, you know that we like our claimants to be super educated about what’s going on, because this is a battle. This is a totally different world. This isn’t about just “I’m disabled, so I get paid.” There is a whole world or history of claims handling that’s gone on by Principal that we know all about from handling these for so many years and doing so many claims. And you need to know how to play this game, so they say.
And so we want you to be more educated. And that’s why we share a lot of this information on the web with you and get reviews from other claimants with Principal so that you’re in the best position possible to get your benefits approved. So we’d look forward to the opportunity to speak with you. And we’ll answer all of your questions should you need us in the future. Thank you.
When it comes to receiving long term disability benefits through Principal Group, it’s helpful to understand how the insurance carrier thinks—and what it will look at when evaluating your claim for benefits. The disability application process is rarely intuitive to someone who doesn’t handle these disability claims day in and day out. But at Dell & Schaefer, our long term disability insurance attorneys have helped thousands of claimants receive and maintain their benefits, and we can help you too. To get started, schedule your FREE consultation by contacting a member of our legal team.