You signed up for long-term disability (LTD) insurance at your place of employment, never expecting you’d need to rely on it. Then suddenly, something happens and you’re home disabled and in no condition to work. You apply to your LTD insurer and they deny your claim. What went wrong?
There can be many “reasons” the insurer will cite for your denial, generally focusing on documentation from your doctor supporting your claim, which they may deem insufficient. Other factors they can cite include your inability to meet qualification standards, or the claim has not been filed in a timely manner.Whatever the reason, you’re stuck. You can’t work, and you have no income.
If you’re in or around Minneapolis, Minnesota, or nearby in Duluth or St. Paul, and you’ve had your LTD claim denied, or your benefits canceled, contact Beedem Law. Our attorneys are experienced in handling long-term disability claims and dealing with insurance company roadblocks and denials. We can work with you to file an appeal and press your claim forward.
Long-Term Disability Basics
Long-term disability insurance is often offered by your employer, or you can purchase it on your own. Either way, there are some basics you need to understand. Many people will assume that their LTD policy will kick in immediately if they become disabled and that it will continue so long as they are unable to work.
However, policy provisions set up some limitations and qualifications. First, there is what is called “the elimination period.” This is anywhere from 30 to 365 days, or it might be keyed to your short-term disability plan. When your short-term policy ends, the LTD kicks in. In any event, you will face a waiting period before your long-term plan begins paying benefits if you qualify.
LTD policies also generally have two definitions of disability: “Own Occupation” and “Any Occupation.” During the Own Occupation period, payments are available so long as the disabled employee is unable to perform his or her regular job. This period usually lasts two years, but can be shorter or longer. After that, the benefits will continue only if the employee is unable to perform any job – the Any Occupation definition.
Most LTD policies also expect people on long-term disability to apply for Social Security Disability (SSDI) benefits. When these kick in, the LTD policy will likely pay only the difference between the SSDI payment and your policy payment, which is usually anywhere from 60 to 80 percent of your pre-disability income. If SSDI is an offset and you receive a retroactive SSDI lump-sum payment, your insurer will expect you to pay them back for the period covered by both Social Security and LTD benefits.
Why Your Claim Is Denied — Avoid Mistakes
To avoid mistakes that lead to denials of your disability claims, the first line of defense is to read your policy and know exactly what it covers and what it requires to justify a claim. You must also pay attention to any exclusionary periods and filing deadlines. If you are denied, you and your attorney can point to verbiage in the policy that challenges the basis of that denial. You can hold the insurer to the letter of its own law.
Insurers are in the business of making money, so it’s not unexpected that they’re going to examine every disability claim with the proverbial “fine-tooth comb”. This means that a denial most likely will be because they deem the documentation you provide to prove your disability to be insufficient.
The insurer will likely have your claim and medical records reviewed by a physician of their choice, whose opinion they will use to evaluate your claim. If their physician’s assessment does not reach the level of total disability, your claim will likely be denied.
They can also question whether a pre-existing condition led to your disability. LTD policies often contain an exclusion period for pre-existing conditions. If your exclusion period is two years, any disability resulting from a pre-existing condition during that time frame will be denied. LTD policies also vary in which conditions they consider to be disabling. It may be that your particular disability is not even covered by your policy. Read the fine print.Your policy may also contain an exclusion or a limited pay period for what is called “self-reported symptoms,” such as chronic pain, fatigue, or dizziness. They can deny your claim if there is such an exclusion, and you are using self-reported symptoms as the basis for your claim.
The insurer can also question whether you remained totally disabled during the elimination period of your policy. Say your policy’s elimination period is six months, and by month six, you’ve recovered enough to return to light duty at work. They will likely deny your claim, or challenge it at the very least.
Another basis for denial is the lack of timeliness in submitting your claim. If you have an employer sponsored plan, the Employee Retirement Income Security Act (ERISA) establishes timelines for disability claims. If they’re not met, the insurer can cite ERISA as the reason for their denial.
Experienced Guidance You Can Trust
Before you file your claim, you should meet with an experienced long-term disability attorney to discuss the best approach. You will need to provide solid documentation that is unambiguous and free of any errors that could be used to deny your claim.
If the insurer requires you to undergo an independent medical examination (IME) as part of the claims process, you need to discuss this with your attorney and get the proper guidance on what to expect and how to handle the exam. Remember, an insurer-paid physician is going to be looking for reasons to undermine or disprove your claim, pure and simple. You need to be prepared for that.
If you are denied, or at some point, the insurer simply cancels your benefits, you’re going to need to file an appeal. Our attorneys can help you with that as well. We know how these LTD insurance companies operate and can help you navigate the obstacles and roadblocks they’ll throw in your way.
If you’re disabled and seeking a claim under your LTD policy, or you’ve been denied or canceled, contact us immediately at Beedem Law. We proudly serve clients throughout the State of Minnesota including the cities of Minneapolis, St. Paul, and Duluth and in the counties of Hennepin, Anoka, and Ramsey.