Any time you file a long-term disability claim, it can be complicated and time-consuming.
If you add an initial denial to that and you have to then go through the appeals process, it’s even more challenging.
Being prepared and knowing what to expect with a long-term disability claim can help you along the way, however.
What Is Long-Term Disability?
Long-term disability insurance can provide replacement income if a worker can no longer do their job because of an injury or illness. You buy an insurance policy and pay premiums that are usually anywhere from 1 to 3% of your salary.
If you become disabled, you have to show that you meet your policy’s definition of disabled, which varies depending on the specifics of your policy.
Benefits will usually cover around 60% of your gross income.
There are two main types of LTD insurance. There’s own-occupation disability insurance, which defines disability as not being able to work at your regular job. There’s also any-occupation disability insurance, which categorizes disability only as of the inability to work in any occupation.
Before you file a claim, you should have a thorough understanding of your LTD policy, because they can vary significantly.
Request all of your plan documents if you have your own policy or speak to an HR representative at your company if you have it through your employer.
Exclusions and Limitations
There are exclusions and limitations with LTD, as is the case with other types of insurance.
For example, an LTD policy typically won’t cover a pre-existing condition, which means for the purposes of these policies, usually something you received treatment for in the 90 days before your coverage’s effective date.
According to Miley Legal, some of the medical conditions that could qualify you for long-term disability benefits include cancer, chronic fatigue syndrome, Crohn’s disease, multiple sclerosis, and lupus.
When you file a claim, it’s important to realize that your insurance company is going to try their hardest to prove you don’t qualify. They’re going to want to see all of your medical documentation, including records and lab tests.
You may then receive a denial.
Sometimes the insurance company will misclassify your illness as a means of denying your claim.
As an additional note, if you file a disability insurance claim, you’ll likely also have to file for Social Security disability benefits. The LTD insurance company can offset your Social Security benefits against the payment of your long-term disability.
So what if your claim is denied?
Don’t Give Up
First and foremost, if your claim is denied, don’t get discouraged and give up. Many claims are denied, and your policy will allow for at least one and perhaps two administrative appeals. Many people ultimately win their benefits during the appeals process.
If you have long-term disability insurance as part of an employer group plan, federal laws require that you use all of your administrative appeals before you can file a lawsuit against the insurance company.
When you receive a denial, there will also be a letter that will explain why your claim was denied and how to appeal.
Your denial letter is incredibly important because it provides you with a roadmap of sorts to begin a successful appeal.
Your denial letter will also have deadlines and filing requirements for an appeal.
If you get a denial letter, request a copy of your claim file from your insurance company, which they are required under federal law to provide for free.
Stack the Record
There’s something called stacking the record to be aware of if your claim is denied. Basically, this means that you get as much favorable evidence as you can.
This includes missing medical records, and you might ask your insurance company if more testing, such as X-rays or MRIs would be helpful.
You should also seek out expert testimony or letters.
Using written observations from people in your life can help strengthen your case too.
Should You Hire an Attorney?
If your claim is denied, you should consider hiring a lawyer. Insurance companies often use the fact that you’re not familiar with a complex process against you, and again, their ultimate goal is to save money for themselves. The earlier you can get an attorney in the process, the more smoothly it’s likely to be, and it raises your chances of a favorable outcome.
Even missing one deadline can ruin your claim.
A lawyer can also work on creating an effective appeal letter and will help you better understand the medical evidence needed.
How to find an Attorney?
Now that you know the importance of finding an attorney, it’s important to learn how to properly do it. Not many people pay attention to this, but finding the right attorney will in most cases be the difference between getting your compensation or not.
Now, there are different ways to find the best attorney for the case, and we’ll tell you all about them. First, it’s probably the best to get a recommendation from a friend or someone who has close contact with a person they can recommend. But, if you are unfortunate and you don’t have anyone like that, then you need to do a bit of research. Worry not, it’s possible to find the best attorney even without close connections.
Using the internet is your best bet. Simply searching for attorneys in your area who work with similar cases like yours is a great start. Then, you can narrow down your list because you’ll probably get a lot of options at first. Start by some sort of pricing, whether by price or by positive reviews that people have made about the service of a certain lawyer. Nowadays you can find feedback so easily by checking websites that exist for only one reason, providing reviews.
Certain lawyers will have different prices as well, so you’ll need to discuss that as well at your first meeting. Some will require a larger percentage of the final compensation, while others will agree to work for a fixed price instead. In any way, being open about the case and discussing it frequently with your lawyer is what matters the most.