Was Your Protective Life Insurance Claim Denied? 

You count on your disability insurance to replace income when you can’t work because of a severe injury or illness. Newfield Law Group is known for holding disability insurance companies accountable for their promises, following the provisions in the policies, and paying benefits according to the terms of the policies.

Many who own Protective Life Insurance disability policies are dentists who purchased policies through the American Dental Association. The ADA provides its members with disability insurance policies through Protective Life, formerly known as Great West. Many of these policies have limitation issues that create many obstructions for dentists who find they need to make a claim for disability insurance benefits.

Jason Newfield has represented many dentists who purchased ADA Disability Income Protection Insurance Plans from Protective Life. Policies are typically purchased when the dentist is just starting out in their practice. This disability policy is priced competitively and exclusively to ADA members up to age 67. They are known as “association” policies, offered to dentists through the ADA, similar to the AMA Own-Specialty Disability Income Protection offered to physicians who belong to the American Medical Association.

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Who Owns Protective Life Insurance? 

Like most disability insurance companies, Protective is a subsidiary of another insurance company, Protective Life Corporation, which sells disability insurance, life insurance, annuities, and other financial products throughout America. Protective itself has a few subsidiary companies including West Coast Life Insurance Company and MONY Life Insurance Company. 

What was “Great-West” Life Assurance Company?

Great-West Life and Annuity Insurance Company’s individual life and insurance business was acquired in 2019 by Protective Life Insurance via reinsurance, including the ADA member insurance plans, but Protective Life Insurance Company began to administer disability claims under the ADA policy. After a period of time, Great-West was phased out and Protective took over the ADA policies. Your older disability insurance documents may be listed as the insurer or in correspondence, but all claims decisions are made by Protective. 

Ironically, Protective’s own website notes that one out of four dentists will disabled long enough to collect benefits at some point before retirement. But the same company eager to sell disability insurance policies to dentists and others is less interested in making good on their promise to pay benefits.

The ownership of Protective is a long and convoluted history, but what the claimant is concerned with is their own claim. Newfield Law Group focuses on getting your claim paid and protected for the long term.

What is a legacy disability policy, and is that a bad thing for claimants? 

When one insurance company buys another insurance company, it’s time to clean house. Disability insurance companies scrutinize policies sold by the prior company to see where they can cut their exposure and limit the amount to be paid out to policy owners. The policies become known as “legacy” disability insurance policies, and policy owners can expect to have their claims investigated. In some cases, requests for more information are the start of the process, while in others, benefits are terminated.

Success Story for Dentist Claim

Our client had multiple claims, and one of the disability insurance companies sought to conduct testing of our client in an effort to develop evidence to use against her claim.  We strategized that having a more functional evaluation utilizing a dummy patient and further replicating the dental field would be the best way to demonstrated the level of functional impairment sustained by the insured.  

We presented for our own testing with the replicated environment and performed a wider array of testing than the one sought and obtained by the disability insurance company.  When time came to compare and contrast results, it was clear that our results were richer to the issues and thus were going to carry the argument.  The insurance company backed down, and our client is now getting paid monthly without further involvement

What Should I Do If My Claim Has Been Denied or Terminated?

The prospect of going up against a huge international insurance company is daunting, and the disability insurance company is counting on a certain percentage of people being too intimidated or too disabled to fight back. Without a strong advocate who knows how to navigate the claims and appeals process, this can quickly become a losing battle.  Developing the necessary support, and providing testing results where appropriate often are critical components to a successful claim for disability benefits.

Once you have received a denial or termination letter, take careful note of the date of the letter and the date the insurance company needs to hear from you. These are firm dates and if materials are not provided by those dates, you may permanently lose your ability to fight for your claim.

Next, request a copy of your claim file from Protective in writing. Claims governed by ERISA (group policies through your employer or association) are required to provide these documents within 30 days of your written request. Even those not governed by this law should provide the underlying claim materials.  You will need to send the request and ensure receipt to provide you proof the letter was received. Disability insurance companies are notorious for losing documents or claiming they were not received, which is why proof of delivery is so important. 

Document every point of contact with Protective. You will want to start a running list of all of your contacts with Protective: every email, hard copy document and phone call needs to be carefully documented. If you cannot manage this, ask a trusted friend, caregiver, or spouse. Also, never send any original documents, including medical reports. You will never see them again.

Review the letter and your original disability policy from Protective. Here is where an experienced disability insurance attorney is needed. Disability insurance policies are legal contracts between you and the insurance company, and they are loaded with legalese, making them difficult to understand. You will need to align the reason given for your denial or termination of benefits with the provisions in the policy. If the letter contains language concerning “own occupation,” you will need to find the provision in the policy that addresses whether or not the policy is an “own occupation” or “any occupation” policy.

If the letter says your medical records do not support your disability claim, you will need to review the medical records sent on your behalf by your treating physician or the ones your doctor gave you to submit with your claim. Medical records are a hot bed of reasons for denials, including:

  • Disability not covered by policy – either excluded or pre-existing.
  • Psychiatric conditions sometimes limited to 24 months of benefit payments.
  • You can work in any occupation.
  • Your job is sedentary and you are able to work.

A careful review of your policy by an experienced disability insurance attorney will reveal whether or not these claims are valid. 

We often find medical records sent by physicians do not contain enough information for the disability insurance claims reviewer to approve a claim. This is expected, as we do not expect the treating physician to know what will and will not support a claim—it is not their job.   We can help guide that process with your doctor.  Certain conditions raise a red flag for Protective, making claims more difficult. These include:

  • Fibromyalgia claims
  • Lower back injury claims
  • Migraine headache claims
  • Lyme disease claims
  • Mental Health claims

Any time a claim is filed concerning an illness where there may not be objective diagnostic tests, Protective Insurance’s medical staffers will dig harder to identify reasons to deny the claim. 

Newfield Law Group has represented individuals who were wrongfully denied disability benefits when all of their medical reports clearly showed severe illness, including MRIs, PET scans and bloodwork. When a claim is filed for a subjective condition that cannot be documented, such as pain, extreme fatigue as a result of Long COVID or a mental/nervous disorder, the likelihood of the claim being denied increases substantially.

Call Our Office to Learn How We Can Help with Your Protective Insurance Claim 

If you are a dentist and purchased your Great-West/Protective disability policy through the ADA, you might expect someone at ADA to help you with your claim forms and to move your claim along. Unfortunately, this is not how it works. Your claim investigation is being administered by the insurance company itself and you can’t rely on Protective, or any other disability insurance company, to look out for your best interest. 

Before contacting Protective to learn why your Great-West/Protective insurance claim is being denied, we invite you to call our office at 877-406-7883. The call is free, there is no obligation, and we will be able to give you useful insights into why your claim is being denied and what you can expect from Protective.

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