Life does not always go according to plan. One day, you are working, providing for your family, and planning for the future. The next, an unexpected illness or injury turns everything upside down, leaving you unable to work and unsure of how to move forward. It is a scenario no one wants to imagine, but unfortunately, it is a reality for many. That is where long-term disability (LTD) insurance is supposed to step in, providing financial support when you need it most.
However, the journey to securing these benefits can be a frustrating process. Denials, endless paperwork, and confusing insurance jargon can leave you feeling overwhelmed. At Kantor & Kantor, we understand what you are going through.
Our San Diego LTD attorneys are here to help, bringing both legal expertise and compassionate support to ensure you get the benefits you deserve. Contact our LTD attorneys at 858-758-4231 for a free consultation.
Call 858-758-4231 to talk to a San Diego LTD insurance lawyer from Kantor & Kantor now.
What Is Long-Term Disability Insurance?
Long-term disability (LTD) insurance is a type of coverage designed to provide financial protection to people become unable to work for an extended period of time due to an injury or illness. Unlike short-term disability insurance, which typically covers disabilities lasting up to six months, LTD insurance is intended to replace a portion of your income for an extended period.
These benefits can cover a significant portion of your income, ensuring you and your family are supported during challenging times. However, obtaining these benefits is rarely as easy as it should be.
Common Tactics Used by Insurance Companies to Deny LTD Claims
Here are some common tactics used by insurance companies:
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 in an attempt 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 as a whole.
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 as primarily based on mental health issues despite your disability being primarily physical.
Common Reasons for LTD Claim Denials
Insurance companies often deny LTD claims for various reasons, including:
1. Insufficient Medical Evidence
One of the most common reasons for denial is inadequate medical documentation to substantiate the disability. Insurance companies require comprehensive, ongoing medical records demonstrating your condition’s severity and duration. They may argue that the evidence provided does not sufficiently prove that you cannot perform your job duties.
2. Pre-existing Conditions
Insurance policies often have exclusions for pre-existing conditions. If the insurance company determines that your disability is related to a condition that existed before your coverage began, they may deny your claim.
3. Policy Exclusions
Long-term disability policies may exclude certain conditions or injuries from coverage. Common exclusions include mental health conditions, self-inflicted injuries, or conditions resulting from substance abuse.
4. Administrative Errors
Clerical or administrative errors, such as missing information, incorrect forms, or missed deadlines, can result in claim denials. Even small mistakes can lead to a denial.
5. Lack of Objective Evidence
Insurance companies prefer objective evidence, such as test results and imaging studies, to support a disability claim. They may deny claims that rely heavily on subjective reports of pain or other symptoms.
6. Retaliatory Actions Against Claimants
In some cases, insurers may retaliate against claimants or their legal representatives for challenging claim denials or filing complaints, such as increasing premiums or threatening to cancel other insurance policies.
7. Ignoring or Misrepresenting Medical Advice
Insurers may ignore or misrepresent medical opinions and recommendations from healthcare providers to support their decision to deny benefits.
8. Lack of Transparency
Insurers may fail to provide clear explanations for claim denials, or the criteria used to assess disability, making it difficult for claimants to understand the reasons for the decision.
9. Unfair Surveillance or Investigation Tactics
Insurance companies may engage in invasive surveillance or investigation tactics, such as covert surveillance or social media monitoring, to discredit claimants’ disability claims.
Why Choose Kantor & Kantor?
When you choose us, you are not just hiring a law firm; you are partnering with a team that genuinely cares about your well-being and future. Here is why our clients choose us to guide them through their LTD claims:
- Experience You Can Trust: Our team has years of experience handling LTD claims. We know the ins and outs of insurance law and have successfully helped countless clients secure the benefits they deserve. You can count on us to fight for you.
- Compassionate Support: We genuinely care about our clients. When you work with us, you are not just another case number. We take the time to listen to your story, understand your needs, and provide personalized support. We are here to lift some of the burdens off your shoulders.
- Proven Track Record: Our history of successful outcomes speaks volumes. We have helped many clients turn their denials into approvals and have secured substantial settlements. Our dedication and expertise have made a real difference in people’s lives.
- Personalized Attention: Every case is unique, and we treat it that way. We do not believe in a one-size-fits-all approach. Instead, we tailor our strategies to fit your specific situation, ensuring the best possible outcome for you.
- Client-Centric Approach: At Kantor & Kantor, every decision is made with your best interest in mind. We tailor our strategies to fit your specific needs and goals, ensuring that your case is handled in a way that maximizes your chances of a favorable outcome.
- Accessibility: We prioritize communication. You will never feel out of the loop or wonder about the status of your case. Our attorneys are accessible and responsive, always ready to answer your questions and provide updates.
How To File an LTD Appeal
Knowing the right steps can make a significant difference, offering a beacon of hope when it seems like the odds are stacked against you. Here is how you can file an LTD appeal, with some practical advice to help you along the way.
First and foremost, it is important to understand why your claim was denied. Insurance companies are required to provide a written explanation detailing the reasons for their decision. This document is your starting point. Carefully review the denial letter to identify any specific issues or gaps that the insurer cited. Knowing these details will help you address them effectively in your appeal.
Gathering and organizing your medical evidence is the next critical step. You will need to compile comprehensive documentation that clearly supports your disability. This includes up-to-date medical records, test results, and any relevant notes from your healthcare providers. If there are gaps or missing pieces in your original submission, now is the time to fill them. Once you have your evidence in order, it is time to draft your appeal letter. This is where you get to tell your story and make a compelling case for why your claim should be approved. Be clear and concise, and ensure you address the specific reasons for denial. Highlight the new or additional evidence you have gathered and explain how it substantiates your claim. Remember, this letter is not just a formality; it is your chance to advocate for yourself and demonstrate the validity of your claim.
After drafting your appeal, it is crucial to review everything meticulously. Make sure all documents are accurate and complete and that your appeal letter clearly articulates your case.
Submit your appeal according to the instructions provided by the insurance company. Make sure you adhere to all deadlines and keep copies of everything you send. This is your safeguard in case there are any disputes about the submission.
Throughout this process, do not hesitate to seek legal help. Filing an appeal can be complex, and having a knowledgeable attorney can make a significant difference. An experienced LTD attorney can assist with organizing evidence, drafting your appeal, and navigating the intricacies of the insurance company’s procedures.
How We Can Help with Your LTD Case
At Kantor & Kantor, we understand how crucial these benefits are to your well-being. Here is how we bring our expertise and empathy to the table to support your case:
Thorough Evaluation of Your Case
Our experienced San Diego LTD lawyers 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 Our San Diego LTD Attorneys Today
Do not let the complexities of LTD insurance overwhelm you. If you are facing a denied claim or need assistance filing your claim, contact Kantor & Kantor, today.
Our team is more than just lawyers—we are people helping people. We are here to lighten your burden, offering not only legal expertise but a supportive ear and a steady hand throughout the process. When you are ready to talk, we are here to listen and help. Together, we will work toward securing the support you need to focus on what truly matters—your health and recovery.
Contact our LTD attorneys in San Diego at 858-758-4231 for 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]
