What Should I Do If My Long Term Disability Claim Was Denied?

If you are unable to work because of a disability, receiving long term disability insurance benefits can be a lifesaver. Unfortunately, the process of getting the benefits you deserve is not always as straightforward as it should be. Insurance companies often unfairly deny claims. Insurance companies have a financial incentive to turn down claims so that they will not have to make payments.

They may turn down claims for minor mistakes in how documents are filled out or for a small piece of missing information. They may say you have not sufficiently proved that you are disabled. It is important to know that you have another chance to make your case. You have the legal right to pursue an appeal with the insurance company. If your appeal is turned down, you have the right to file a lawsuit in federal court.

You are not alone. In fact, many legitimate long-term disability claims are initially denied. The problem is getting worse. The percentage of denials due to technical errors in long-term disability insurance claims has reached an all-time high in recent years.

With the right evidence and guidance, many long-term disability claims are approved on appeal. But you must put together a compelling disability appeal that includes enough evidence to overwhelm the insurance company. Getting legal help from an experienced long term disability insurance lawyer will give you the best chance possible to get your denial overturned.

It is incredibly frustrating to go through the claims process only to receive a denial letter saying that your claim for the benefits you need and deserve was denied. We advise channeling that frustration into action. Contact the experienced Washington, D.C. long term disability benefits attorneys at Donahoe Kearney as soon as possible to get a timely start on your appeal.

What is ERISA? 

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that imposes certain requirements on voluntary employer-provided retirement, life insurance, health insurance, short-term disability, and long-term disability plans. If your employer paid all or part of the premiums for your long-term disability coverage, or you purchased a private disability policy, then you are most likely protected by ERISA rules. These rules regulate:

• How disability claims must be processed
• The deadlines  for processing the claims
• Your rights if your claim is denied

While ERISA provides some important protections, long term disability insurance companies can still unfairly deny your claim. Remember, these insurance companies have a built in conflict of interest. The same companies that will pay you benefits also have the power to approve or deny the claim. The more claims an insurance company denies, the more money it will save.

ERISA allows you to appeal the insurance company’s decision if your claim is denied. If the appeal is also denied, ERISA gives you the right to file a lawsuit against the insurance company or against your employer.

Why Hire a Long-Term Disability Claims Attorney if Your Claim Was Denied? 

Insurance companies try to avoid paying benefits whenever possible. The insurance industry’s business model incentivizes companies to try to save money by denying claims whenever they can. They may seize upon any technicality they can find to deny what would otherwise be a legitimate long-term disability claim. This is unfair to claimants with valid claims whose medical conditions make them unable to work.

Fortunately, there is a limit to what long-term disability insurance companies can get away with when dealing with ERISA claims. The insurance companies have to comply with ERISA regulations, which give claimants the right to appeal the insurance company’s decision and, if the appeal is also denied, to sue the insurance company in federal court.

Many long-term disability claims are denied initially, then approved during the appeals process. Filing an appeal, though, is a complex process. By hiring a long-term disability claims attorney, you can increase your chances of getting a favorable result. An attorney will take your side, protect your interests, and produce a strong appeal. Your attorney will do all of this within the deadlines ERISA and the insurance company set for submitting your appeal.

Common Reasons for Long-Term Disability Claim Denials

Insurance companies deny claims made on their long-term disability insurance policies for two main reasons. They may point to a technical problem or claim they based their denial on a medical reason.

Technical Denial

An insurance carrier may issue a technical denial when the claimant does the following:

• Misses a deadline
• Does not follow the correct procedures when filing.
• Was not disabled long enough to qualify

Technical denials may be based on trivial mistakes, such as typos in filling out the claim forms. Sometimes people filling out claim forms do not understand all of the questions or terminology on the forms. This may cause them to make innocent mistakes, which the insurance company will seize upon as a reason to deny the claim.

Medical Denial 

To qualify for long-term disability benefits in Washington, D.C., you must demonstrate that you are disabled according to the definition of “disabled” that your insurance policy uses. For example, some policies state that you are disabled if you are unable to carry out the duties of your job for medical reasons. Other policies require that you be unable to carry out the duties of any job.

A medical denial typically involves situations where the insurance company claims that:

• Your disability does not meet the requirements as stated in the policy’s definition of “disabled.”
• Your policy does not cover your disability.
• Your condition is not serious because you are not receiving regular medical attention.
• You have failed to prove you are disabled.

Sometimes, denials are the result of insurance company errors. For example, the insurance company might:

• Improperly evaluate your claim and supporting documents
• Fail to have have your specific medical condition and disability reviewed by doctors with the right qualifications and specialty
• Fail to consider all of the medical evidence – MRIs, diagnostic tests, lab results

If your claim is denied, you should obtain a copy of your insurance policy and read it as the first step in determining whether the denial was proper or not.

Process for Appealing a Long-Term Disability Claim in Washington, D.C.

You will need to take several steps to appeal your long-term disability denial.

Read the insurance company denial letter carefully. Under ERISA the insurance company letter denying benefits needs to contain important details of what you need to do to file an appeal, including the deadline for doing so.

The denial letter will also explain why the insurance company denied your claim. Understanding their reasons is important because it will let you know what information, evidence, and documents you need to provide to the insurance company in your appeal.

For example, if your appeal was denied because the insurance company says your doctors did not document your restrictions and limitations you will need to submit more evidence from your medical providers or take additional medical tests to prove you are disabled under the policy. An experienced Washington, D.C. long-term disability insurance denial attorney will know how to craft your appeal based on the reasons given in the notice.

If your claim was denied, get a copy of your long-term disability insurance policy. This should be available from your employer’s human resources department or from the insurance company. Next, you need to request a complete copy of your claim file — this will be hundreds of pages to over a thousand pages, and you need to review it carefully to plan your appeal. You have a legal right under ERISA to receive these documents.

When you have the documents, review them to understand the insurance company’s reasons for the denial of benefits. A long term disability attorney can help with this step using his understanding of the language, terminology, and conditions found in these insurance policies.

If you received a denial of benefits, be sure that you know exactly what was missing from your initial claim. You only get one chance to submit evidence, so be careful to include everything necessary.

If your denial was based on medical reasons, check to find out if the insurance company obtained all the medical records that they should have to reach their decision. Often, they fail to do so. Find out which medical records they used. Review your medical records with your doctor and other medical experts and supplement the medical evidence with reports that specifically address the insurance company’s denial.

The easiest and most effective way to appeal a long-term disability denial is to hire an experienced long-term disability lawyer. The sooner you can start working with an attorney, the better. Your lawyer will stand up for you when dealing with the insurance company and gather any additional necessary evidence to strengthen your case.

Deadline to File an Appeal

The deadline for filing an appeal to a claim denial is short. If you miss a deadline, you may lose your right to appeal, so you must act quickly. Under ERISA law, you may have only 180 days to appeal a denial. The exact timeframe will be stated in the denial notice sent by the insurance company.

You should contact a Washington, D.C. long-term disability insurance denial lawyer as soon as possible after you learn that you were denied disability benefits. The more time your attorney has to prepare your appeal, the better. It takes time to research your case, obtain statements from witnesses, consult with vocational and medical experts, arrange for you to take any needed medical tests, talk with and get statements from your treating physicians, write a powerful appeal, and assemble the evidence and other documents that will support your appeal.

Gathering More Evidence To Benefit Your Case

The best way to win an appeal is to overwhelm the insurance company with evidence. The attorneys at Donahoe Kearney understand the importance of this tactic, and we vigorously put it into action. Our standard appeals range from about 28 to 33 single-spaced pages. We often include hundreds of pages of exhibits and other evidence to help prove your eligibility for long-term disability benefits. This evidence covers the time period starting when you were injured up until the present, providing a complete and thorough picture of your medical condition and the ways it prevents you from being able to work.

Depending on what information is relevant to your claim, the vocational and medical evidence you and your attorney will gather for your long-term disability case may include the following:

• Written statements from your doctors and specialists about how your disabilities limit what you can do at work
• Additional medical tests, such as CT scans, MRIs, blood tests, or X-rays
• Written testimony from a vocational expert giving their professional assessment of which jobs (if any) you are able to do and which you are not able to do, given your medical condition or injury
• Written statements by the people who know you (co-workers, family and friends) describing what they have observed of your limitations

The Donahoe Kearney legal team will guide you through the process and prepare the written appeal, ensuring that it is done in a timely manner to meet the strict deadlines.

What Happens if My Appeal is Denied? 

If your appeal is denied, you have the right to file a lawsuit in federal court seeking a ruling on the insurance company’s decision. It is important that you consult with a long-term disability attorney if you decide to take this step. Filing a federal lawsuit is not a do-it-yourself project.

Many cases settle before they are decided by a judge. Your attorney will negotiate with the insurance company seeking a fair settlement agreement. Your attorney will advise you on the range in which a fair settlement amount should fall. However, the final decision about whether to accept a settlement offer is up to you. If the insurance company does not make a settlement offer you want to accept, the next step is to file a lawsuit in federal court.

If you win your lawsuit in court or reach a settlement before trial, you will start receiving the appropriate benefit payments. The judge may also award you past interest and attorneys’ fees.

Before making any decisions about whether you should file a lawsuit, you should consult a long-term disability insurance attorney to get advice on whether you have a good case for pursuing a lawsuit. If it makes sense to sue, you should seriously consider doing so. The purpose of long-term disability benefits is to enable workers to take care of themselves and their families when they can no longer work. You should not let the insurance company’s wrong decisions stop you from fighting for your right to get all the benefits that you have earned.

A Denial is Not the End of Your LTD Claim

If your long-term disability claim is denied, this is not the end of the road. Many denials are overturned on appeal.

With help from the right law firm, you can fight for your right to get all the long-term disability benefits that the law provides. At Donahoe Kearney, we have the in-depth knowledge of disability law and the experience to give you the legal advice and assistance necessary to prepare a strong appeal with overwhelming evidence of your right to receive disability benefits.

We are dedicated to helping workers get the benefits they need and deserve. If you hire us, we will:

• Use our experience in insurance law to analyze the insurance policy and the insurance company’s entire claim file, which may include up to 30 different types of documents and information.
• Obtain additional medical information when relevant, including working with your treating physicians.
• Work with experts and consultants.
• Explain the insurance policy’s definition of “disability” to your physicians and obtain statements from them on how that definition applies to your medical condition.
• Arrange for any additional medical tests that will provide further evidence of your disability.
• Find out more about any doctor whose report your insurance company uses in its decision.
• Have our medical research professional conduct research on your condition.
• Conduct interviews with other people who do your job, if the definition of your job duties is at issue, to determine if the actual job functions differ from the official version.
• Interview witnesses and draft statements.
• Prepare a detailed appeal of approximately 30 single-spaced pages.
• Attach copies of hundreds of pieces of evidence and information to overwhelm the insurance company with facts favorable to your case.
• Stand up to the insurance company on your behalf and prevent them from trying to take advantage of you.
• Deal with the legal process and the insurance company so that you can focus your time and energy on healing.

Contact us today for a free consultation. We will gladly review your denial letter and advise you on what to do next.