Unfortunately, many claims for long-term disability (LTD) benefits are initially denied—regardless of their merit—but then later proven on appeal and approved. This may be surprising to learn as you diligently paid your LTD premiums every year/month and you would expect your LTD carrier to diligently pay your LTD claim. However, be mindful that the more claims an insurance company denies, the money they get to keep for their executives and shareholders. They have a financial incentive to deny your claim, at least at the outset to see how hard you will fight to recover the benefits you are entitled to. Prove to them you are a fighter and do not give up! Many claims that were initially denied are approved on appeal.
However, the appeal process is complicated and contains many hidden pitfalls that LTD claimants are not aware of. If your claim for LTD benefits was initially denied, the best time to bring an experienced insurance attorney on board to assist you with your claim would be at this juncture, before you file an appeal. LTD appeals are complicated and must contain all of the necessary evidence to prove your disability. You likely do not know what all evidence is required or would be helpful. Why risk it? Get an experienced LTD attorney, like our attorneys at Taylor, Warren, Weidner & Hancock, involved and make sure your record on appeal is “packed.” This will greatly increase your chance that your LTD claim will eventually be approved. Here are some additional tips you can follow for filing an appeal if your LTD carrier initially denied your claim.
Understand Why Your Long-Term Disability Claim Was Denied
The first step in preparing to file your long-term disability appeal is understanding why your LTD claim was denied. The reason for your insurance company's denial will be stated in the denial letter they sent you. Read it carefully. Some of the common reasons we have seen in our many years assisting professionals with their LTD claims are:
- The claimant hasn't been disabled long enough to qualify;
- The condition isn't covered (or is considered pre-existing or excluded);
- The claimant was not receiving regular medical treatment for the condition/disability;
- Lack of proof of the disability or limitations, or the insurance company feels the evidence does not support a disability; and
- Failure to use the proper forms to file or within the applicable deadlines.
Understanding why your long-term disability claim was denied is the first step in appealing the denial. The denial letter may also state additional information that was needed that you failed to provide – certain forms or records or evidence. Study your denial letter carefully to see if it provides a roadmap or any guidance on how to cure your failed claim. The denial letter should also explain how and when to file your appeal. Mark these deadlines on your calendar to ensure you meet them.
Gather Any Missing, and All the Medical, Information
If your LTD denial letter pointed to some form or other piece of information that was missing, gather the missing information immediately to ensure you include it with your appeal. Then, focus on the medical evidence. It is quite common for LTD claims adjusters or plan administrators to fail to gather the entirety of your medical records. Do no rely on them to establish your disability. Immediately begin requesting copies of all your records (including imaging, x-rays, MRIs, lab and blood results, etc.) from all your providers to provide those to your insurance company.
“Pack Your Record" With Strong, Supportive Evidence
The best thing you can do to ensure you file a strong, persuasive appeal of your initial LTD denial is to “pack the record,” i.e., provide as much evidence as possible of your disability and your limitations. Often requests for medical records that come from a doctor's own patient are filled much quicker than a request from an insurance company. You can greatly improve the chance your LTD claim will be approved by being your own advocate in the gathering of your medical records and requesting all records yourself then submitting those to your insurance company and ensuring they were received and added to your claim file.
Determine If You Should Undergo More Tests to Support Your Disability
Your insurance company's determination as to whether you are disabled will hinge on your medical records and the opinions and statements of your treating physicians. If the types of tests and results that would help prove your disability are not in your record, this could have a negative impact on your LTD claim. Ask your doctor, LTD claims adjuster, or an experienced LTD insurance attorney, if further objective testing would help your case. You may do a great service to your LTD claim if you obtained the following tests and results that support your disability.
- CT scans
- Lab and blood tests
The more concrete, indisputable evidence you can provide that supports your disability, the better your chances will be of recovering the LTD benefits you deserve.
Vocational and Other Non-Medical Evidence
This is where an experienced LTD insurance attorney can really help. You likely will not know what types of non-medical or other expert testimony and evidence would help your LTD claim. There are numerous key pieces of evidence insurance companies often look for, and generate on their side in their favor, that can help support your disability and get your initial claim denial overturned. These often include:
- Statements from coworkers, colleagues, or friends and family attesting to your symptoms and limitations;
- Testimony and/or a detailed report from a vocational expert (a person who specializes in analyzing what jobs a person can perform and how certain impairments impact the ability to perform certain jobs)
Evidence from a vocational expert can be particularly helpful if you have an "any occupation" LTD policy, because this type of policy defines disability as the inability to engage in any job, not just your current job, i.e., your “own occupation. You can learn more about these two occupational definitions here.
Ask Your Doctors for Written Opinions
In addition to records generated as a matter of course—your medical records—think about asking your physician to write an independent written report documenting your symptoms and limitations, specifically stating the job duties you can no longer perform, or cannot perform without pain. Your doctor may require you to pay an additional fee for her to prepare such a report, but it will be a cost that serves you well in the long run. This, too, is where a skilled LTD attorney can help assist by knowing what questions to ask your doctors to elicit the right type of information to support your disability and improve the chances of getting your denial overturned. If your doctor is not willing to help with your case by preparing the necessary LTD paperwork, and you believe your condition is severe, consider switching doctors. A favorable doctor's opinion is that important.