Legal Question in Insurance Law in Pennsylvania

Insurance Claim Appeals

My husband has been recieving long term disability insurance for 14 months. The insurance company has just closed his claim because his Dr. failed to submit medical information when it was requested. If he appeals this decision does the insurance company have to continue paying on his claim until a decission is made?

The insurance company is located in New York.


Asked on 1/09/04, 8:57 am

2 Answers from Attorneys
Scott Diamond DIAMONDLAWYER

Re: Insurance Claim Appeals

you need to get help. the docotor may be liable for not fillling out the forms. In additioin, you probabaly can re-apply for the LTD once the doctor submits the idsability statement. Otherwise, you are going ot have to sue

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Answered on 1/09/04, 9:10 am
Richard Teitell Richard K. Teitell, Esquire, P.C.

Re: Insurance Claim Appeals

This becomes a complicated question and depends, in part, if the policy is a private policy or is controlled by a law known as ERISA. The short answer is that the ins co does not necessarily have to resume payments. But the ins co has a duty to act in good faith. If there's no evidence that your husband is recovered, it probably will resume the payments. Hope that helps.

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Answered on 1/09/04, 3:41 pm


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