If you’ve developed a medical condition that has made it impossible for you to work, you've likely filed for long-term disability (LTD) either through your employer’s policy or one you purchased on your own. However, it’s possible that your claim was denied.
Approximately two-thirds of all initial LTD claims are denied by insurance companies. It’s important to understand why these claims are denied and what you can do to ensure the best possible chance that yours receives approval.
Appealing an LTD Claim Denial
Filing for LTD can be a frustrating and stressful process, and insurance companies that handle LTD policies employ a variety of tactics that allow them to deny your claim. Once the insurance company has denied the claim and you want to appeal, there are things you need to do to help ensure you’re not denied again, including:
- Hire an attorney. When you apply for LTD, the insurance company managing your policy isn’t interested in your well-being. Insurers are more concerned with the bottom line and making sure the company remains financially healthy. If the insurance company approves fewer LTD claims, its profit margins will be higher. LTD attorneys understand these strategies and how to deal with them. They are experienced in the Employee Retirement Income Security Act of 1974 (ERISA) and know the federal law that governs LTD and other insurance coverage. Additionally, insurance companies seem to give more serious consideration to those disability cases that have legal representation. Hiring an attorney before you file your initial LTD claim is most often the best approach.
- Don’t trust the insurance company. Your LTD application will be evaluated by a claims examiner who works for the insurance company—which is not only a conflict of interest, it almost ensures that your initial claim will be denied. Because the examiner will not be penalized if he denies your claim, and his main objective is to avoid paying, even an honest, valid claim will likely be denied—forcing you to appeal. It’s very possible the insurance company will delay and deny your claim, and then it will aggressively defend the denial in court when you’re forced to bring a lawsuit to obtain the LTD benefits you deserve.
- Provide sufficient medical evidence. You must provide specific medical records about your condition and how it affects your ability to work, as well as an opinion statement from your treating doctors. When the insurance company receives your claim, it will request all your records and any doctor statements. Don’t assume that the claims examiner will collect all relevant medical records for your case. It’s critical that you follow up with the insurance company; periodically review your claim file; and check for any missing lab reports, medical findings, or test results. The examiner will also look for proof that you’re receiving ongoing medical treatment for your condition, you’re seeing a doctor regularly, you’ve received all necessary tests, and that you’re following treatment plans.
Contact Marcus Vaden Law
If you need to file an LTD claim, it’s important that you find an attorney who has experience handling LTD cases and is well-versed in ERISA law. Legal representation is not only critical after your claim has been denied but before you submit it. Call Marcus Vaden Law today for a free consultation.