Having your claim for long-term disability denied can be frustrating, not to mention discouraging. But it’s important to remember that insurance companies deny more long-term disability claims than they approve — even if those claims are legitimate. And you do have legal options.
Long-Term Disability Denied? Here Are Some Common Reasons Why
Each disability claim is different, and LTD insurance companies deny claims for all kinds of reasons. The majority, however, are denied because of simple mistakes or because the insurance company is trying to avoid paying out on a valid claim. Here are some of the most common reasons for a denial:
Lack of Sufficient Medical Evidence
Sometimes, an insurance adjuster will deny an LTD claim because there’s just not enough evidence supporting a claim. You may have omitted one of your doctors from your application, or you may be missing some medical records. Other times, the insurance adjuster may not have done their job properly and decided not to order all of your medical records. Or you may have neglected to consistently make your doctors’ appointments, which could complicate your medical evidence.
The Adjuster Says You’re Not Disabled
LTD policies have strict definitions of disability. Depending on your long-term disability plan, you may have to show that you are unable to do your past work — or any other work in the region. But there’s a lot of nuance involved in this analysis.
For example, the adjuster may decide to follow work restrictions assigned by an insurance company doctor, rather than those from your treating physician. In some cases you may find that even though the doctor never even examined you, they still issued an opinion based on their limited review of some of your medical records.
You Made a Procedural Error
Long-term disability claims, especially ones involving employer-sponsored or ERISA plans, have strict deadlines. Missing even one of these deadlines or skipping a step in the process could lead to getting your claim for long-term disability denied. To prevent this, it’s in your best interest to consult with an experienced LTD lawyer early on in your claim.
Surveillance Suggests You Can Work
We see it all the time: a private investigator “cherry-picks” surveillance footage or your social media feed, implying that you can work. While we know that surveillance rarely, if ever, shows the whole story, an insurance adjuster will be all too eager to use this “damaging” footage against you.
What Should I Do If My Long-Term Disability Is Denied?
Don’t give up on your claim. A disability lawyer can review your long-term disability plan and build an appeal strategy.
Steps to Take Before Appealing
As soon as you receive a denial notice, make sure to take the following steps:
- Get a copy of your Summary Plan Description and identify the following:
- Whether your long-term disability plan is covered by ERISA (i.e.; employer-sponsored)
- How much time you have to file an appeal
- The exact definition of disability contained in the plan
- Any exclusions or limitations that apply to your claim
- The exact appeal procedures required by your plan
- Request a copy of the insurance company’s “administrative file,” which includes any of the medical records it ordered and reviewed
- Schedule a consultation with a disability insurance lawyer
These steps can do a lot to bolster your claim and get it moving in the right direction. The information contained in your long-term disability plan documents will also frame your lawyer’s legal strategies and help them identify the next steps you need to take.
Understanding the Deadlines Involved
If you have an ERISA plan, it’s important to understand that you must follow a very strict procedural framework when you appeal an LTD denial. Generally speaking:
- You have 180 days to appeal from the date of receipt of the denial or termination letter
- Your insurer has 45 days to respond to your appeal
- Your insurer is allowed one additional 45-day extension
- If your insurer upholds the termination/denial of benefits, your only recourse is to file suit in federal district court
An insurance company may deny your claim for any number of reasons — even if you have strong evidence and qualify for LTD benefits. That’s why we encourage every long-term disability claimant discuss their case with an experienced lawyer. We can help you identify mistakes that the insurance company made, gather evidence you need to file an appeal, and ensure that you avoid making costly mistakes.
A Birmingham AL Long-Term Disability Lawyer Can Help
If you had your claim for long-term disability denied, contact Petro Law Firm as soon as possible. The sooner you consult with an experienced disability lawyer, the sooner we will be able to start preparing your appeal and building a legal strategy. Call today for a free consultation.