Long-term disability (LTD) insurance is a beacon of hope for injured people struggling in the aftermath of an accident. If your disability continues longer than six months, your LTD insurance will cover your needs as long as your disability lasts. For this reason, it’s best to immediately file for a claim application to receive benefits as soon as possible.
But what do you do if your claim gets denied?
Why LTD Applications Get Denied
The Employee Retirement Income Security Act (ERISA) is a federal law that governs all established health and pension plans in private organizations, which include employer-provided long-term disability policies. As per ERISA, claim administrators who work for the insurance company are in charge of evaluating the claims. Due to the inherent conflict of interest, claim adjusters deny deserving claims even if there is clear evidence of disability.
There are different reasons behind an adjuster’s denial. Some of the most common include the following:
- Insufficient medical evidence
- Video surveillance inconsistent with allegations of disability
- Failure to meet the policy’s definition of disability
- Missed deadlines
If an adjuster denies your claim, don’t lose hope. Some insurance companies initially deny claims, regardless of their merit. With persistence, patience, and the help of experienced disability insurance lawyers in Los Angeles, you can still appeal for your insurance claim. However, there can be strict and short time limitations for appealing a denial of disability benefits, so you must determine the deadline and act quickly to submit your appeal.
Appealing Your Denial: The First Steps
Get a copy of the policy. Obtain a copy of your long-term disability policy documents, which should also include the summary plan description. You can get it directly from the insurer or from your company’s human resources department (for businesses that provide group insurance). If both parties fail to provide these documents, you can request them from the insurance company’s plan administrator.
Study your denial letter. With your disability attorney, review the denial letter sent by the insurance company. Take note of the reasons behind the claim’s rejection and gather other information to support your claim’s approval. Don’t forget to mark deadlines on your calendar, too.
Strengthen Your Case with Favorable Evidence
Track down missing records. In some cases, plan administrators and insurers fail to obtain all the medical records relevant to your claim. Strengthen your appeal by finding out which records were used to decide your case. If anything is missing, let your claims administrator know and determine the date when they received and requested all the records.
Find out if medical tests would help. Most insurance companies cite the lack of medical evidence as a basis for denying your claim. Get in touch with your claim administrator and ask if medical testing, such as blood tests, MRIs, or x-rays, would help your case.
Seek your doctor for a written opinion. Ask your doctors to provide a written opinion that lists down work-related limitations caused by your injury. A disability insurance lawyer can help you craft specific questions to ask your physicians.
When you’re injured or unable to work, disability insurance can help you get back on your feet as soon as possible. Reap the benefits of your insurance by avoiding claim denial or appealing for it with the help of a trusted disability insurance attorney.
Haffner Law’s team of lawyers are eager to assist. Get in touch with us today and let us fight for your rights.