Individual’s suffering from a serious illness or injury, who are unable to continue working, often turn to long-term disability insurance for needed income. If your LTD claim is denied, it is important to work with an experienced attorney who specializes in ERISA law to help you prepare a long-term disability denial appeal.
Reasons LTD Benefits are Denied
The process starts by understanding why your claim was denied. Your attorney will carefully review the denial letter sent by your insurance company explaining why your claim was rejected.
Reasons may include: the health condition is not covered; the health condition is pre-existing; the period of being disabled is not long enough to qualify; there is no record of regular medical treatment for the condition; proof of disability is lacking or not convincing; or the claim is missing required documents/deadlines were not met.
It is important to compare the reason for the denial against the LTD policy, which your attorney can get from your HR department if applicable, or directly from the insurer. The plan administrator is required to provide this information under the Employee Retirement Income Security Act (ERISA).
Appealing an LTD Claim Denial
If your claim was denied on a technical issue, your attorney will direct you to gather the necessary information or submit missing documentation. If it is a matter of lacking evidence, your attorney will obtain medical evidence to strengthen your case, which may include:
Additional medical evaluations or testing to strengthen your case. Sometimes, further objective testing can strengthen a case which may include MRIs, CT scans, X-rays, or blood tests. More medical evidence can help in the appeals process.
Obtaining opinions of doctors. A compelling argument for LTD benefits often comes from a treating physician or specialist who can provide first hand testimony of the limitations (disability) the medical condition imposes on their patient.
Obtaining opinions of vocational experts. Vocational experts can attest to the types of jobs a worker with impairments can and cannot do, which is particularly useful information if a disability impacts a worker’s ability to engage in any job, not just the current one.
Providing non-medical evidence such as written observations from family or friends concerning an applicant’s limitations can strengthen a case. Observations of those closest to you can put the injury or illness in the context of everyday life, where an injury or illness can make performing everyday activities – rising from bed, walking, lifting, eating a regular diet, resting comfortably and more – difficult if not impossible.
Other pertinent information. Your attorney will review your case to determine what information will strengthen your case and guide you in the appeals process to achieve the best possible outcome.
If your LTD claim is denied because of missing a form, for example, it may be possible to simply submit what is needed to get the process back on track. Often a denial is not that straightforward; there may be more than one reason given for denying LTD benefits. Therefore, consulting an attorney is advisable if your LTD claim is denied for any reason before proceeding.
When appealing an LTD claim denial, it is crucial to get it right the first time by “stacking the administrative record” with favorable evidence because courts often refuse to consider [new] evidence other than what was presented to the insurance company or plan administrator in the internal appeals process. An experienced attorney will know what needs to be included in the appeal so that you have the best chance of success.
Contact an Experienced LTD Insurance Attorney
If you are filing an initial claim or have been denied long term disability insurance, it is advisable to work with an experienced LTD attorney to pursue the best outcome in your case. Individuals and families who are dealing with a disability often depend on long term disability insurance for income during a difficult time so it is important to have an experienced and knowledgeable advocate on your side. Contact the long term disability attorneys of Alan C. Olson & Associates for immediate assistance at 262-785-9606.
