Long term disability insurance benefits were designed to protect individuals and families in case they become sick or injured and can’t create an income. Unfortunately, insurance companies seem to look for any reason to deny those benefits rightly owed to you. The reality is the insurance industry's main focus is to make a profit for their shareholders, leaving their policyholders unprotected. You may finally get paid a benefit, but don’t expect it to happen quickly or easily.
Filing a Long Term Disability Claim in Florida
Long-term disability insurance (LTD) claims are typically filed with a private insurance company. If your policy was employer-funded, it’s controlled by the federal Employee Retirement Income Security Act of 1974 (ERISA). This law sets out a variety of legal requirements as well as procedures that impact your claim.
Every LTD policy is different. The first step towards receiving your long term disability benefits is reviewing the policy’s summary plan description (SPD). This document generally outlines the long term disability plan’s requirements, procedures, deadlines, and other important information. You should be able to get a copy of your SPD directly from the insurance company or your Human Resources department. However, if you need help getting this or other documents, consult with a long term disability benefits lawyer immediately.
Assessing Your Eligibility
Once you have the plan’s SPD, you can assess your eligibility for long term disability benefits. Next, you’ll file an application for benefits. This typically includes a series of forms and releases. If you have questions about a form or need help completing them, it’s in your best interest to schedule an appointment with an experienced LTD lawyer. It’s also a good idea to submit your medical records and supporting letters from your doctors and other experts. Again, a long term disability insurance claims attorney can help you compile your evidence.
Once the insurance company has your claim, it will start its investigation. This might involve the following:
- Reviewing your medical records and statements
- Sending you to a one-time examination with an insurance company doctor
- Asking a team of their physicians to review your claim
- Hiring a personal investigator to monitor your daily activities
- Consulting with vocational experts about your ability to transition to other work
Based on its review, it will either approve or deny your claim. You should receive a letter advising you of this decision.
Why Are Long Term Disability Insurance Claims Denied?
Many employers offer their staff long-term disability as an employee benefit. These policies are supposed to provide you and your family with financial assistance when you can’t work for an extended period of time. Even if your short term disability claim was quickly approved, you might face insurance company challenges during a long term disability claim.
The primary reason for this is cost. Long term disability insurance claims are much more expensive to pay out. Depending on the terms and conditions of your LTD policy, you might be eligible for income assistance for years. To avoid the expense, insurance companies fill their policies with complex exclusions, narrowly define “disability,” and carefully scrutinize long term disability insurance claims. Unfortunately, they deny most claims — including ones where the disabled worker really qualifies for benefits.
The insurance company might deny your LTD claim due to:
- Confusion about your diagnosis and the severity of your limitations
- Competing medical opinions about your ability to work
- Missing information and evidence
- Missed filing and appeal deadlines
- Narrow “any employment” disability definitions
- Policy exclusions that limit payments to certain types of medical conditions
- Surveillance footage that shows you performing daily activities
While many denials involve honest disputes, insurance companies sometimes deny long term disability insurance claims in bad faith.
You Have the Right to Appeal a Denial
After an LTD denial, you have the right to appeal — and you should take this option seriously. However, don’t delay. Long term disability insurance claims typically have strict appeal deadlines. If you miss these deadlines, or fail to submit all of your evidence to the insurance company, you might lose your right to compensation.
If you need help understanding your company’s LTD carrier denied your claim, contact the CJ Henry Law Firm today. We carefully review our clients’ claims and help them understand their legal options. And because our team has extensive medical and legal experience, we have unique insight into long term disability insurance claims. Request your free consultation today!
An Experienced ERISA Lawyer Can Help You With an Appeal
After a long term disability insurance claims denial, it’s understandable that you feel frustrated and afraid. However, you should never take the insurance company’s denial at face value. Instead, quickly consult with an experienced long term disability lawyer at the CJ Henry Law Firm. Depending on your circumstances, we might be able to help.
It’s also important to note that that as time passes, long term disability insurance claims become more complicated. There are two levels of appeal in an LTD claim:
- Administrative: filed with the insurance company itself
- Federal court: submitted to a federal court judge for review
The processes and procedures vary for each form of appeal. For example, while you can (and should) submit supporting evidence at the administrative appeal level, federal court judges cannot review newly submitted evidence. Instead, they can only look at the “administrative record,” the information the insurance company had when it decided your claim.
If you need help “stacking” your administrative record with supporting evidence, contact our office immediately. We’ll listen to your story, review your evidence, and help you understand how to proceed.
Don't Fight Alone
Without an experienced disability attorney, you will have a hard time fighting against an insurance company on your own. Insurance claim examiners are trained to look at even the smallest details that could disqualify you from the claim you rightly deserve. Many people have been denied disability benefits because they were captured on video, appearing not to be disabled. Many times, an ERISA lawyer can help you with your initial claim and identify exactly what you need to win your case or appeal. These videos can be unfair and misleading — and we’ll do our best to overcome the footage with compelling evidence.
Get the Benefits You Deserve
Even a small step in the wrong direction could be detrimental to the success of your case. If you’re in Brandon, Lakeland or the surrounding areas in Florida, please contact us. We will make sure you receive guidance on how to respond to your disability insurance provider and how to conduct your life without affecting your case negatively. Count on our legal experience to make sure you receive the benefits you are owed.
Words cannot express my sincere appreciation to Attorney Claudeth Henry for the professional services in representing me with my disability claim. Your knowledgeable expertise helped to process my claim immediately without delays. Thank you for your genuine work ethics and care for your clients. May God continue to soar you to greater heights.Brenda Vereen