Skip to main content

You have worked hard all your life, and now, due to no fault of your own, you find yourself unable to earn the income you once did. The financial strain and uncertainty about the future can compound the physical pain and emotional stress.

When your health and livelihood are on the line, you need someone in your corner who truly understands and cares about your situation. That is where our long-term disability (LTD) insurance attorneys in San Jose come in. We are not just lawyers; we are people helping people, and we are here to fight for your benefits.

Our team at Kantor & Kantor knows the ins and outs of LTD claims. We have seen firsthand how insurance companies can make the process difficult, often denying claims for reasons that seem unfair or unjust. But we believe that you should not have to navigate this challenging path alone. We are here to provide the support and legal expertise you need to overcome these obstacles and secure the financial assistance essential for your future.

Contact our San Jose LTD insurance lawyers at 408-539-0081 for a free consultation.

What Is Long-Term Disability?

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.

Examples of Common Disabling Conditions Covered by LTD Insurance

Long-term disability insurance is designed to protect you when serious health issues prevent you from working. But what conditions are typically covered? Here are some common disabling conditions that often qualify for LTD benefits:

  • Chronic Pain and Fibromyalgia: The constant discomfort can make even simple daily tasks feel impossible. If you are struggling to manage your pain and it is affecting your ability to work, you may be eligible for LTD benefits.
  • Neurological Disorders: Neurological conditions, such as multiple sclerosis, Parkinson’s disease, and epilepsy, can cause severe physical and cognitive impairments. These conditions can progress over time, making it increasingly difficult to maintain employment.
  • Cardiovascular Diseases: Heart attacks, strokes, and other cardiovascular diseases can have life-altering consequences. Recovery can be long and uncertain, with many people unable to return to their previous level of work.
  • Cancer: Treatments like chemotherapy, radiation, and surgery can be exhausting and leave you unable to work. LTD insurance can cover you during your treatment and recovery period, providing peace of mind during a difficult time.
  • Musculoskeletal Disorders: Conditions affecting the bones, joints, and muscles, such as arthritis, back injuries, and spinal disorders, can be extremely painful and limiting.
  • Autoimmune Diseases: Autoimmune diseases like lupus, rheumatoid arthritis, and Crohn’s disease can be unpredictable and debilitating. Flare-ups and ongoing symptoms can interfere with your work and daily life.
  • Respiratory Disorders: Chronic respiratory conditions, including COPD, severe asthma, and pulmonary fibrosis, can make it difficult to breathe, let alone work. LTD insurance can provide coverage if these conditions prevent you from maintaining employment.

Appealing a Denied LTD Claim

If you have received a denial letter, here is a guide on what you can do to appeal the denial.

1. Understand the Reason for Denial

First things first, read the denial letter carefully. It will specify why your LTD claim was denied. Knowing exactly why your claim was denied is crucial for determining your next steps.

2. Review Your Policy

Look over your policy documents to confirm details like the definition of disability, coverage exclusions, and the appeals process. This knowledge will arm you with the essentials to challenge the denial effectively.

3. Collect Additional Evidence

Consult with your healthcare providers to gather more comprehensive medical records, detailed physician’s statements, and any other relevant documentation that supports your disability claim. This could also include new test results or diagnoses that were not previously submitted.

4. Write an Appeal Letter

Once you have all the necessary information and additional evidence, it is time to draft an appeal letter. This letter should clearly address the reasons for the denial stated by the insurer, supported by new evidence and expert opinions. It is not just about presenting facts but telling your story in a way that humanizes your daily struggles and the impact of your disability.

5. Consult an LTD Attorney

Navigating the appeals process can be complex. Consulting with an experienced San Jose LTD attorney can increase your chances of success. An attorney can help refine your appeal, handle legal complexities, and, if necessary, represent you in court.

Why Kantor & Kantor Should Represent You

When you are dealing with a long-term disability, the last thing you need is the added stress of battling an insurance company for your benefits. At Kantor & Kantor, we know how this process can be, and we are here to make it easier for you.

How Our Attorneys Can Help You

Thorough Evaluation of Your Case

Our experienced San Jose 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 Jose LTD Insurance Attorneys Today

Facing a long-term disability is undoubtedly one of life’s most challenging hurdles. It is not just the physical or mental health struggles but also the financial uncertainty that can weigh heavily on you and your family.

We believe that everyone deserves the right to a dignified existence, especially when facing such profound challenges. That is why we fight to ensure our clients receive the benefits they are entitled to. We are not attorneys; we are people helping people, and we are here to fight for you.

Contact our San Jose LTD insurance lawyers at 408-539-0081 for a free consultation.
Attorney Glenn Kantor, California

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]