If you feel you are suffering from a medical condition or symptoms that have limited your ability to perform the material duties of your job, you may have started thinking about filing a claim to recover your long-term disability (LTD) benefits. The LTD claims process will be a tedious one, with many chances where you could make a misstep. In addition to bringing on an experienced insurance attorney, like our attorneys at Taylor, Warren, Weidner & Hancock, here are some critical steps you can follow to improve your chance of recovering your LTD benefits.
Obtain and Review Your LTD Policy
You should request a complete copy of your LTD policy from either your insurance agent or your employer (if your LTD coverage is provided through your employer), including the Summary Plan Description. This will help you understand your policy's definition of disability, the material duties of your job, the short-term and long-term coverage you have, as well as any exclusions or limitations on the benefits you can recover. It is important to be familiar with these terms and their meanings before filing your claim for LTD benefits.
Support Your Claim with Medical Evidence
The most important evidence you will want to obtain and submit to support your claim for disability will be your medical records and the opinions of your treating physicians. We have provided guidance on how to work to ensure your medical records contain the necessary elements to support your disability but—in addition to ensuring the necessary records are generated—you will also want to make sure all the records get to your LTD insurance company. Do not assume your carrier will gather all records. Ask your doctors and medical providers for copies of your records and submit them to your insurance company. In addition to all records and physicians' notes, you should also include all imaging, MRIs, x-rays, and lab results.
Insurance Company's Investigation and Claim Decision – Typically 45+ Days
Upon receiving your claim for LTD benefits, your LTD insurance carrier will begin an investigation. They will look through your medical records and will likely reach out to your treating physicians and other medical providers to ask questions. They may even talk to your colleagues, coworkers, or other people to verify—or challenge—your claim that you are disabled. You should advise your doctors (especially, but also colleagues, coworkers, family, and friends) that you will be filing a claim for LTD benefits and inform them they will likely be contacted by your LTD carrier so they will be prepared to speak coherently about your symptoms and limitations. You may also be asked to undergo an Independent Medical Examination (IME) where a doctor hired by your LTD carrier will examine you to determine the extent of your disability or limitations. After your insurer completes its investigation—most policies require this to be completed in 45 days with allowance for a 30- or 45-day extension—it will inform you of its claim decision, i.e., whether it will approve or deny your claim for LTD benefits.
Appeal of a Denial of a Claim for LTD Benefits – 180 Days
(Critical Moment to Hire an Attorney)
If your LTD insurance company denies your claim for LTD benefits, you will want to file an appeal with your insurance company. This is a “mission critical” moment in the claims process. If you had not already, you should contact an experienced insurance attorney, like our attorneys at Taylor, Warren, Weidner & Hancock, to assist you with the filing of an appeal. We have seen too many LTD applicants take a misstep at this critical phase and cost themselves their LTD benefits. An attorney can help you ensure your “records is packed,” meaning all records and evidence that is necessary, which will include vocational evidence, is included in your appeal. It is imperative that your appeal contain ALL evidence possible to prove your disability because it is the only record the court will be able to review if you have to file a lawsuit after your LTD carrier denies your appeal. Depending on your policy, you may be required to file a second appeal before filing a lawsuit.
File Suit for the Court to Review the Denial of Your Appeal
If your insurance company denies your appeal, you will want to seek court review of that decision. Your policy may state the time within which you must file a lawsuit. The timeline for filing suit will likely differ if you have a privately issued LTD policy versus an E.R.I.S.A. policy. If you decide to seek court review of your denial, do not wait to act. The deadlines for filing are strict and, if not adhered to, may result in a court's refusal to review your denial. The suit will be initiated by the filing of a Complaint in federal court, to which your insurance company will have to respond within a certain number of days, then discovery and motion practice will begin. Remember no new evidence of your disability or limitations can be produced at this point. The court can only look to what was submitted in your claim file and appeal file. For this reason, bringing an experienced insurance attorney on board before you file an appeal of your initial denial is the best move you can make to protect your rights and your claim for LTD benefits.