COMMON REASONS LONG-TERM DISABILITY CLAIMS ARE DENIED
Jan. 20, 2022
Employers frequently offer employees long-term disability (LTD) insurance policies designed to help make up for lost wages if one becomes disabled and unable to perform duties at work.
Employees can also opt to purchase LTD policies from a private insurer that can be transportable from job to job or fill the gap when an employer does not offer a sponsored LTD plan.
Regardless of how you obtained your LTD policy, if you become disabled and unable to continue working, you expect your insurance coverage to kick in and make up for your lost income, even if just a guaranteed percentage of your regular wages.
Employees are often in for a big surprise when trying to make a claim on LTD policies. Employees likely have paid premiums monthly for years and when they make a disability claim, with support from the employee’s doctors, they expect the insurer to honor its obligation to pay benefits. Instead, employees may receive a letter denying benefits for several reasons, usually based on what the insurers call “lack of sufficient medical evidence.” Now what? What can be done when an employee faces a total loss of income while trying to recover from your disability?
Before the denial, employees can also consult with our attorneys helping to avoid some of the errors that often doom disability claims. If you have been denied, you need to file an appeal. Our experienced disability insurance attorneys can help you present the best possible evidence and argument for the denial to be reversed and the insurance company to honor its obligation to pay benefits.
Beedem Law is knowledgeable and experienced in the LTD claims and appeals process. Before you file, or if you are denied, call us immediately. We proudly serve clients in Minneapolis, St. Paul, Duluth, Minnesota, and throughout the counties of Hennepin, Ramsey, Dakota, and Anoka.
Reasons for LTD Claims Denials
Probably the number-one reason for an LTD claim denial is, as mentioned above, lack of sufficient medical evidence in the eyes of the insurer. Depending on the nature of your disability, your initial claim should include not only your physician’s evaluation, but also copies of X-Rays, MRI results, and any other tests confirming your condition. If you are receiving treatment, include records of that as well.
Insurers, when in doubt, may also ask you to submit to an independent medical examination (IME) with a physician or medical group of the insurer's choosing. If you fail or refuse to submit to the IME, you risk the insurer denying your disability benefits claim.
Another reason for denial is that you failed in the insurer’s eye to submit your claim and documentation in a timely manner. Policies generally have clauses regarding the timeliness of your claim and strict requirements as to when the insurer requires you to provide notice of your claim. When it comes to appeals, if you miss the window you have in which to file, you may have failed to exhaust your administrative remedies and be forever barred from suing the insurer.
Your condition may also not meet your insurer’s definition of disability. You need to check the fine print in your plan, or at least the summary plan description offered at work if you’re using an employer-offered LTD plan. Some policies have provisions about pre-existing conditions, and the insurer may deny your claim if it believes your disability comes from a condition you had prior to purchasing the policy.
Policies may also contain clauses about “own occupation” and “any occupation.” Some policies may pay if your condition prevents you from performing the tasks of your current occupation, while others may hinge benefits on your ability or inability to perform “any occupation.”
Most policies combine the two. For example, it may pay for two years for your inability to work your “own occupation” and then demand you take on “any occupation” that your condition and past work experience allow you to perform.
Insurers also may hire a surveillance crew to follow you around and take pictures and videos of what you do in your daily routine. If you appear to be healthy enough to take care of the needs of your life, that can be used to reject your claim or to cancel your benefits if previously approved.
Likewise, if you post pictures of yourself on social media doing things that are outside of your stated abilities, the insurer will be sure to use that as evidence against your claim.
Work with Trusted Long-Term Disability Attorneys
The bottom line is to remember that insurance companies are in the business to make money, so insurers have an incentive to challenge every claim and limit liabilities. Some, of course, are more willing to go the extra mile in finding reasons for denial.
To avoid giving the insurer reason to doubt your claim and then deny it, you must present an initial package of documentation that substantiates the condition that is causing your disability and inability to work. That’s where having a strong legal team on your side can make all the difference.
We at Beedem Law know how the big insurance companies operate, and we can anticipate reasons for denials. We can help you prepare a powerful package of proof to submit along with your claim, and if you are still denied, we have the knowledge and experience needed to file a strong appeal.
If you are in Minneapolis, St. Paul, Duluth, Minnesota, and throughout the counties of Hennepin, Ramsey, Dakota, and Anoka, contact Beedem Law to help you with every step in the long-term disability claim process.