Long-term disability (LTD) insurance promises a safety net when you are unable to earn an income due to a serious illness or injury. Unfortunately, the process of securing LTD benefits is seldom straightforward.
Many who apply for these benefits find themselves facing denial letters instead of the support they were promised. It can leave you feeling vulnerable and confused. You did everything right, so why the denial?
The reasons for these denials can be varied and often feel frustratingly bureaucratic. Each denial has its own backstory, with individuals struggling to make sense of complex policy language while also dealing with devastating health issues.
At Kantor & Kantor, we understand the challenges you face when dealing with LTD denials. We are here to offer the guidance and support you need to navigate through the appeals process, helping you reclaim the benefits you rightfully deserve.
We are here to help you get the insurance claim you need to move forward. Contact our long-term disability lawyers at 818-886-2525 to request a consultation.
Common Reasons for LTD Claim Denials
Knowing the common reasons behind these denials can give you a better chance of successfully appealing or even avoiding issues in the first place. Here are some of the top reasons for LTD claim denials.
1. Insufficient Medical Evidence
Insurance companies typically require detailed and concrete medical evidence to prove that a disability is severe enough to prevent someone from working. Claims are denied because the evidence submitted does not sufficiently demonstrate how the condition impacts daily activities or job performance.
2. Pre-existing Conditions
Many LTD policies include clauses that exclude coverage for disabilities stemming from pre-existing conditions. If an insurance company believes your disability is due to an illness or injury that occurred before you were covered under their policy, and you filed your claim within a certain amount of time after obtaining your LTD coverage, they may deny your claim.
3. Failure to Follow Treatment
If you are not receiving regular medical care or treatment at all, the insurance company may deny your claim. They may argue that your condition could improve with proper treatment, potentially allowing you to return to work. Ignoring medical advice or failing to follow prescribed treatments could also be used to justify a denial.
4. Lack of Objective Evidence
Certain conditions, especially those that involve mental health or chronic pain, can be difficult to quantify with physical tests. Insurance companies might deny claims that appear to lack objective, measurable evidence of disability.
6. Missed Deadlines or Incomplete Paperwork
Insurance companies require claimants to submit all required paperwork and meet certain deadlines to process a claim. If you miss a deadline, fail to provide all requested documents, or do not answer all questions thoroughly, your claim could be denied on a technicality.
Additionally, many policies pay benefits only after a certain period if you are unable to perform “any occupation” as defined in your policy. The insurance company may determine that while you cannot perform your own job, you are still capable of working in another capacity, which could lead to a denial of benefits.
What to Do if Your LTD Claim Is Denied
Many LTD claims are denied initially, and often the denial can be appealed successfully with the right approach. Here is a guide on what to do next if you find yourself in this situation.
1. Review the Denial Letter Carefully
When you first receive a denial letter, it is natural to feel angry, disappointed, or even hopeless. But it is important to take a step back and review the denial letter thoroughly. The letter should explain the reasons for your denial.
2. Gather More Information
Once you understand the reasons behind the denial, gather additional information to support your claim. This can include additional medical records, statements from your treating physicians, or even testimonies from colleagues, family, or friends about how your condition affects your daily life and ability to work. Also, obtain a copy of your LTD policy and your entire claim file from the insurer to see all the documentation that was considered in your case.
3. Contact an Attorney and File Your Appeal
The process of appealing a denied LTD claim can be complex, especially if you are already managing the challenges of a disabling condition. An experienced LTD attorney can make a huge difference in building a strong appeal.
When you are ready to submit your appeal, make sure you do so before the deadline (usually within 180 days of your denial). Your appeal should include all the new evidence you have gathered, a clear explanation of why the denial was incorrect, and a request for reconsideration.
At Kantor & Kantor, we handle LTD denials and understand the tactics insurance companies use to deny claims. We will work with you to gather evidence, communicate with the insurance company, and make sure your appeal is comprehensive and compelling.
How Our Attorneys Can Help You with Your LTD Claim Denial
Here is how our team can support you every step of the way in fighting for the benefits you deserve.
Thorough Evaluation of Your Case. When you come to us with a denial, we start by conducting a thorough evaluation of your case. This includes reviewing your denial letter, your policy, and any correspondence from your insurance company. We will discuss the specifics of your medical condition and how it impacts your life and ability to work.
Gathering Critical Evidence. A successful appeal often hinges on presenting a robust body of evidence. Our team works closely with medical professionals, vocational experts, and other specialists to gather the necessary documentation to support your claim.
Building a Strategic Appeal. The appeals process for LTD claims is time-sensitive and requires a strong, well-organized argument. We will carefully draft and submit your appeal, using our extensive experience with disability claims to address the specific reasons for your denial and pre-emptively counter any arguments the insurance company might use to uphold their decision.
Handling Communication with the Insurance Company. When you work with us, we will handle all communications with the insurance company. We also know how to push back on unreasonable demands. If the insurer requests redundant or irrelevant information, we will make sure they understand that we are holding them to the legal standards of your policy.
Navigating ERISA’s Complex Framework. If your LTD benefits are provided through an employer, your claim is governed by ERISA. ERISA imposes strict rules and deadlines, and it can be hard to fight an insurance company on your own.
Our attorneys are adept in handling ERISA cases, and we understand the law’s many nuances. We will make sure you do not miss any critical deadlines, and we will handle all communication with the insurance company to ensure your rights are fully protected.
Taking Your Case to Court, If Necessary. If your appeal is denied, you still have options. We are prepared to take your case to court if that is what it takes to secure your benefits.
Our attorneys have experience litigating LTD claims and know how to build a case that holds up in court. While many claims are successfully resolved during the appeals process, we will stand by you every step of the way and take on the insurance company in court if that is what is needed.
Contact Us for LTD Legal Support Today
Insurance companies often rely on complex policy language and strict requirements that can feel impossible to meet, especially if you are going through this process alone. They may count on your not appealing the decision or your fear that you do not have the energy or resources to fight back.
At Kantor & Kantor, we have the experience, resources, and focus to tackle the tactics used by insurance companies, and we are here to help you build a comprehensive appeal that strengthens your claim.
Contact our LTD lawyers at 818-886-2525 to request a consultation.
