When your health takes a turn and you can no longer work, it does not take long for the fear to set in. How will you pay your bills? How long will the insurance company take to respond? What happens if they say no?
We know the system is not always fair. You have worked hard and paid into your insurance, and when you finally need support, the process can feel cold, confusing, and even hostile. Insurance companies are more focused on protecting their bottom line than honoring their promises.
Long-term disability (LTD) claims are often anything but straightforward. Whether your condition developed gradually or you were sidelined by a sudden health crisis, insurance companies are quick to question, challenge, and deny claims.
You may be asked to fill out endless paperwork, defend your symptoms, or jump through hoops just to get the benefits you were promised. It is exhausting and unfair.
We at Kantor & Kantor are more than just your attorneys; we take pride in helping you through this process. Our approach is comprehensive. From the moment you reach out to us, we start by listening to understand the specifics of your situation and how your life has been affected.
This initial conversation is crucial for building a strong foundation for your claim. We handle all aspects of the legal process, from reviewing your policy and gathering essential medical evidence to filing detailed appeals and, if necessary, litigating on your behalf.
Contact our Oregon LTD attorneys at 818-886-2525 to request a free consultation. We are people helping people and we are here to help you get the LTD benefits you have earned.
Long-Term Disability Policy Types and Options
Here is a breakdown of the most common long-term disability policy types and some key features to know:
Group Long-Term Disability Policies
If you are employed or part of a professional association, you may be covered under a group LTD insurance policy. These policies are commonly offered as part of an employee benefits package, with premium costs typically shared between you and your employer.
Group LTD coverage offers peace of mind, providing a financial safety net if you are unable to work due to illness or injury. However, it is important to fully understand the specifics of your policy, including:
- Policy Exclusions: Some conditions, especially pre-existing ones, may not be covered, which could affect your eligibility for benefits.
- Premium Contributions: Know how much you are responsible for and what portion your employer is covering.
- Benefit Duration: Each policy is different, so be sure to review how long your benefits will last if you are deemed disabled.
Individual Long-Term Disability Plans
If you are not covered by a group plan or want additional protection, an individual LTD policy may be the right choice. These plans offer more flexibility and customization, allowing you to tailor the policy to meet your personal and financial needs.
Individual LTD policies often include enhanced features like optional riders that can increase your coverage. For example, a cost-of-living adjustment (COLA) rider ensures your benefits keep pace with inflation over time.
One of the biggest advantages of an individual plan is the ability to choose your benefit period, which can range from a few years to lifetime coverage. This lets you balance premium costs with the level of protection you want.
Additionally, individual policies often provide higher benefit amounts than group plans. By investing in an individual LTD policy, you are taking a proactive step to secure long-term financial stability in the event of a disability.
Common Reasons Long-Term Disability Claims are Denied
Insurance companies often deny claims for reasons that are not fair or even accurate. Here are some of the most common reasons why LTD claims are denied:
1. Selective Review of Medical Evidence
Insurance companies may selectively review medical records to downplay the severity of your condition or overlook crucial evidence supporting your disability. They may focus on minor details while disregarding the overall impact of your impairment.
2. Surveillance
Insurers may conduct surveillance on claimants to discredit their disability. They may hire private investigators to monitor your activities, looking for any evidence that contradicts your claimed limitations. Even if they do not observe you contradicting your stated abilities, they may try to portray whatever they do observe as somehow in conflict with your credibility.
3. Independent Medical Examinations (IMEs)
Insurance companies often require claimants to undergo IMEs by their chosen physicians. These exams may be biased towards the insurer’s interests, resulting in assessments that underestimate the severity of your condition or deem you fit for work prematurely.
4. Allegations of Malingering or Exaggeration
Insurance companies may accuse claimants of malingering or exaggerating their symptoms to prolong disability benefits unlawfully. They may use inconsistencies in medical records or subjective assessments to cast doubt on the legitimacy of your claim.
5. Policy Interpretation
Insurers may interpret policy language to favor the denial of benefits. They may exploit ambiguous terms or exclusions in the policy to justify their decision, even if it contradicts the original intent of the coverage.
6. Limiting Benefits
Most policies have limitations for mental health disabilities, capping the amount payable to two years of benefits. Insurers may try to classify your claim primarily based on mental health issues despite your disability being primarily physical.
The Appeals Process Explained
Appealing a denied LTD claim involves several steps, each with specific timelines, requirements, and potential outcomes.
The first step is reviewing the denial letter, which outlines the reasons your claim was rejected. Carefully read the denial analysis to identify the weaknesses in your original application and determine what additional evidence or clarification is needed.
If your policy is through your employer, it is likely governed by a federal law called ERISA (the Employee Retirement Income Security Act). Under ERISA, you typically have 180 days from the date of your denial to file an administrative appeal.
The next step is gathering new evidence to support your appeal. This may include updated medical records, expert opinions, witness statements, or further medical testing. Submitting strong, relevant evidence with your appeal can significantly impact its success.
Once your appeal is submitted, the insurance company typically has 90 days to make a decision. During that time, they may request more information or order another review, but they must follow strict timelines and procedures. If they still deny your claim, that is when we can take them to court.
When you hire Kantor & Kantor to handle your appeal, we dive deep into your case. We review the denial letter, your medical records, your policy, and every piece of correspondence with the insurer.
We work with your doctors to get detailed statements, gather expert opinions if necessary, and make sure your file is complete, accurate, and compelling. We know what insurers look for and what they try to ignore. We will hold them accountable and make it impossible for them to justify another denial.
Why Choose Kantor & Kantor?
We have spent decades taking on insurance companies that refuse to play fair. Whether your policy is employer-provided and governed by ERISA, or you purchased an individual plan, we know how to get results. Here is why so many people across Oregon trust us with their long-term disability claims:
We Know Disability Law Inside and Out
Long-term disability cases are complex. We know the rules, the loopholes, and the strategies insurance companies use to deny valid claims.
We Treat You Like a Person, not a Case File
We understand the emotional, physical, and financial toll that disability can take. You will never be treated like just another claim on a desk. Our attorneys take the time to listen to your story, answer your questions, and walk with you through every step of the process.
We Get Results
We have helped thousands of people in Oregon win the disability benefits they were wrongfully denied. Insurance companies know our name, and they know we do not back down.
We Are with You from Start to Finish
Whether you are filing a claim for the first time, appealing a denial, or preparing for a lawsuit, we will be by your side every step of the way. From helping you gather medical records to representing you in federal court, we are in this together.
How Our Oregon Long-Term Disability Attorneys Can Help Your Case
When you are dealing with a health crisis, the last thing you want is to fight alone against a large insurance company that is more interested in its bottom line than your well-being. Our Oregon long-term disability attorneys are here to lift that burden from your shoulders.
Here is how we can help:
- Thorough Evaluation of Your Case: Our experienced Portland metropolitan-based LTD lawyers, serving the entire state of Oregon, will thoroughly evaluate your case to determine the strength of your claim. We will review your insurance policy, medical records, and other relevant documentation to assess your eligibility for benefits.
- Strategic Claim Preparation and Submission: Preparing and submitting an LTD claim requires attention to detail and thorough documentation. We will assist you in gathering the necessary evidence and completing the required paperwork to ensure your claim is submitted accurately and on time.
- Claim Denial Appeals: If your claim is denied, we will not hesitate to challenge the decision through appeals. Our attorneys have extensive experience in handling claim denial appeals. We will thoroughly review the denial letter, identify the reasons for denial, and develop a strong appeal strategy. Whether it involves providing additional evidence, challenging the insurer’s decision, or filing a lawsuit, we will do whatever it takes to fight for the benefits you deserve.
- Litigation Support: In some cases, litigation may be necessary to secure the benefits you deserve. If negotiations with the insurance company are unsuccessful, we are prepared to take your case to court and present a compelling argument on your behalf.
Contact a Long-Term Disability Lawyer serving Oregon Today
If your LTD claim has been denied, delayed, or you are just starting the process and want to make sure it is done right, contact us today. The earlier we are involved, the better we can protect your rights and maximize your chances of success.
At Kantor & Kantor, we understand what you are going through. We know how frustrating it is to be unable to work, to worry about making ends meet, and then to be told your claim does not qualify.
Our experienced Oregon long-term disability attorneys are ready to stand by your side, guide you through the process, and fight for the benefits you have earned. We will listen to your story, answer your questions, and give you honest, compassionate advice about your options.
Contact our Oregon LTD attorneys at 818-886-2525 to request a free consultation.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
