Filing for long-term disability (LTD) benefits can be a lifeline for individuals who can no longer work due to illness or injury. However, many claims are denied for a variety of reasons.
If your long-term disability claim has been denied, it’s important to consult with an experienced long-term disability attorney who specializes in disability law. With legal representation, you have a better chance of successfully overturning the denial and securing the benefits you need to support your recovery and financial stability.
Here are some of the most common reasons why LTD claims are denied:
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Insufficient Medical Evidence
Many claims are denied because the applicant did not provide enough medical documentation to prove that their condition prevents them from working. Insurance companies require detailed and specific evidence to validate the claim.
Failure to Meet the Policy’s Definition of Disability
Every LTD insurance policy has a specific definition of what constitutes a “disability.” If your condition doesn’t meet the criteria outlined in the policy, your claim may be denied.
Pre-Existing Conditions
Claims may be denied if the disability is related to a condition that existed before the coverage began. Many policies include exclusions for pre-existing conditions, which can disqualify a claim.
Lack of Objective Medical Evidence
Conditions that are difficult to quantify, such as chronic pain or mental health disorders, often result in denials due to the lack of objective medical evidence that insurance companies typically require.
Non-Compliance with Treatment
If you do not follow your doctor’s prescribed treatment plan, the insurance company may deny your claim on the grounds that you are not making efforts to mitigate your disability.
Surveillance and Social Media Activity
Insurance companies sometimes use surveillance or review social media activity to find evidence that contradicts your disability claim. Any perceived discrepancies between your reported condition and observed activities can lead to a denial.
Missed Deadlines or Incomplete Paperwork
The LTD claims process is strict about deadlines and documentation. Missing a filing deadline or submitting incomplete paperwork can result in an automatic denial.
How to Appeal a Long-Term Disability Denial
If your LTD claim is denied, you have the right to appeal the decision. Here are the steps you should take:
- Review the Denial Letter: Carefully read the denial letter to understand the specific reasons for the denial. This will guide your appeal strategy.
- Gather Additional Evidence: Collect any missing or additional documentation that can strengthen your case. This may include updated medical records, expert opinions, or statements from healthcare providers.
- Submit a Detailed Appeal Letter: Write a comprehensive appeal letter that addresses each reason for the denial and provides supporting evidence. Be sure to meet the deadline for submitting your appeal, which is typically 180 days from the date of the denial.
- Consult an Attorney: Long-term disability claims can be complex, and the appeals process may require legal expertise. A disability attorney can help you navigate the process, gather the necessary evidence, and advocate on your behalf.
- Prepare for Potential Litigation: If your appeal is denied, you may have the option to file a lawsuit against the insurance company. This step should be taken with the guidance of an experienced attorney.
Resolve Your LTD Denial
A denial of your long-term disability claim can be a significant setback, but it’s not the end of the road. By understanding the common reasons for denial and following the appropriate steps to appeal, you can increase your chances of obtaining the benefits you deserve. Remember, the process can be challenging, but you don’t have to face it alone. Consulting with an experienced long-term disability attorney can provide the support and expertise needed to navigate the appeals process successfully.
