Does the insurance company have to act in a fair manner during my appeal?

Allan W. Ben, PC: Under an ERISA case, the general rule is that they have to provide you a "full and fair" review. As for an Individual Policy, they are required to act in accordance with the terms of the policy, which usually contain a clause dealing with fair dealing. Does that mean that they routinely deliver on that promise? Usually no. There are some insurance carriers who do the right thing, but more likely, are the carriers who are overly concerned with their bottom line, and not the person suffering from a disability. Usually, if the carrier can interpret something to their benefit, or in such a way that they can "justify" termination or denying your benefits, they will. Some insurance companies have a history of evaluating disability claims in a biased manner and you should ask your attorney for further information.

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