Denied Long-Term Disability Coverage? What’s Next?

Denied Long-Term Disability

Today, an increasing number of Americans face the denial of long-term disability coverage.

Unlike social security disability, your employer provides long-term disability coverage through an insurance company.

The coverage is governed by a federal law called the Employee Retirement Income Security Act (ERISA).

Insurance companies deny long-term disability applications for a number of reasons. If your insurance company denied your application, you have the right to appeal under ERISA. You can file a lawsuit against your insurance company if it denies your appeal.

If you have been denied long-term disability coverage, you should talk to a disability attorney today. A disability attorney can help you navigate the complex process of overturning disability insurance coverage denials.

Why Might an Insurance Company Deny My Long-Term Disability Application?

Insurance companies often deny long-term disability applications because of insufficient medical evidence, the inability to meet the definition of disability in your policy, and inconsistent evidence from video surveillance.

Insufficient Medical Evidence

Your inability to obtain sufficient medical evidence often arises from a failure to get regular medical treatment. No matter what kind of condition you have, insurance companies want to see that you are regularly seeing medical professionals.

Medical professionals include your primary care physician and any appropriate medical specialists. For example, if your disability arises from a mental condition, you should be seeing a psychologist regularly.

Additionally, your claim might be denied for insufficient medical evidence because you don’t have a statement from your doctor saying that you have the disability you claim. Your doctor should provide you with a detailed opinion of your medical limitations and how they relate to your job.

It is important that your doctor’s medical opinion is in the form of a letter. Having your doctor use a form provided by your insurance company is more likely to result in another denial.

Inability to Meet Your Policy’s Definition of Disability

Often, insurance companies deny people long-term disability coverage because they don't meet their policy’s definition of disability.

Some insurance policies use an “own occupation” definition of disability while others use an “any occupation” definition. An “own occupation” definition means you are disabled if you cannot carry out the duties of your particular job.

However, an “any occupation” definition means you are disabled if you cannot perform the duties of any job. Whether your policy uses an “any occupation” or “own occupation” definition can have a significant impact on your case.

It is also important to understand that some conditions might not qualify under your policy’s definition of disability. For example, an insurance company will usually deny a disability application for a disability that is the result of substance abuse.

A disability attorney can help you decide if your disability meets your policy’s definition.

Inconsistent Evidence from Video Surveillance

Sometimes, investigators from insurance companies will follow and videotape you to confirm that you have the disability you claim. If investigators see you doing things that are inconsistent with the disability you say you have, they might deny your claim.

As a result, it is important to follow your doctor’s instructions regarding activities you should and should not perform. For example, you shouldn’t shovel snow if you’re not supposed to lift heavy objects.

How Do I Appeal My Denial of Long-Term Disability Coverage?

ERISA governs the appeal process for long-term disability claims. In addition to reading the information below, you should also check your denial letter to see whether it describes the appeal process.

Timelines

Under ERISA, you have 180 days from the date of your denial letter to file an administrative appeal. You file your appeal with the plan administrator. The plan administrator then has 45 days from the date of your appeal submission to respond with a decision.

Writing Your Appeal Letter

Your appeal letter needs to address every reason for denial of your long-term disability coverage stated in your denial letter.

Additionally, you should include in your letter information that you didn’t include in your initial disability application. Specifically, your appeal letter should include:

  • The reasons your insurance company denied your application for long-term disability coverage;
  • Policy language that supports your disability claim;
  • Specific reasons why you believe your insurance company should cover your disability claim;
  • A discussion of your medical condition and why it prevents you from working;
  • Reference to supporting evidence, including case law;
  • Any new or updated medical records that support your claim; and
  • Contact information for you, your doctor, and any other relevant individual.

To make sure that your appeal letter is written as well as possible, you should consult a disability attorney. An attorney can write your letter and make sure it includes all the necessary information and evidence.

Contents of Your Appeal

You should use as much evidence as possible to support each reason for overturning your denial of disability coverage stated in your appeal letter. Examples of supporting evidence include:

  • Medical, financial, and employment records;
  • Your claim file, including your doctor’s opinion on your medical limitations;
  • Correspondence between you and your insurance company; and
  • Third-party reports from friends, coworkers, and family members about your disability and how it affects your ability to work.

If your insurance company denies your appeal, the next step in the process is an ERISA lawsuit. The success of an ERISA lawsuit depends on the quality of the information contained in your appeal because you cannot submit any new information. A disability lawyer can make sure that you submit the best quality appeal possible.

Why Should I Contact a Disability Lawyer?

Contacting a disability lawyer can help improve the chances that your long-term disability coverage denial will be overturned. 

The process of overturning the denial of your long-term disability coverage is complicated. A disability lawyer can help you avoid making mistakes that lead to further denials, such as including inaccurate or misleading information. Additionally, working with a disability lawyer can give you leverage against your insurance company.

John Peace at the Peace Law Firm has been fighting insurance companies on behalf of disabled individuals since 2002. John can help you:

  • Gather all the supporting information needed for your appeal;
  • Draft your appeal letter;
  • Include as much supporting documentation as possible; and
  • Ensure that your appeal is filed on time.

Contact John today to schedule your free consultation.

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