Many of our personal injury clients have injuries which prevent them from working for different periods of time and frequently they must go on long-term disability. Unfortunately, insurance companies will often deny their legitimate long-term disability claim to avoid having to pay out the benefits owed.
Conditions That Lead to a Long-Term Disability
There are many conditions that can lead to a disability including, amongst many others:
Long-term Disability claims are often denied for a lack of supporting medical evidence, even when your doctors support your disability, or because the insurance company’s adjuster has decided that you can go back to work, even when your doctor disagrees.
Long-term disability is something that’s there to give the insured peace of mind that if injury or illness occurs there will still be a source of income to address the continuing costs of life. When you are counting on these benefits to see you through a hard time having them denied can be a devastating.
Types of Long-Term Disability Policies
There are, generally speaking, two types of long-term disability policies. There are group policies which you get coverage under from work, often without a medical examination, and will usually exclude any pre-existing medical issues from coverage. Then there are private policies which usually require a medical examination before an insurance company will agree to underwrite your policy. Insurance companies will deny legitimate claims on both types of policy, but private policies sometimes contain unique contract provisions that often require a lawyer experienced in long-term disability law to interpret.
Own Occupation Period vs. Any Occupation Period
When dealing with a long-term disability claim it’s important to keep in mind that the definition of what is considered “disabled” under your policy can change. While it’s dependent on the specific insurance policy you are covered under, most long-term disability policies require you to be unable to complete the essential duties of your job due to injury or illness to be considered disabled for the purposes of long-term disability for the first two years of your disability. This is called the “Own Occupation Period” as you are only required to be disabled from your own occupation. Usually, at the two year mark the definition for being disabled under your insurance policy changes from being unable to complete the essential duties of your job due to injury or illness to being unable to complete the essential duties of any job due to injury or illness. This is known as the “Any Occupation Period” and it has a much higher threshold to meet the policy definition of disabled. It is often at change over to the Any Occupation Period that most long-term disability benefits are denied.
The Internal Appeal
If your long-term disability benefits have been denied of cut off your insurance company will likely offer you the right to appeal their denial through their internal appeal process. These appeals are long and arduous and almost never succeed as it is the same people, with the same evidence (usually any further evidence you could supply will only bolster your treating medical professional’s opinion which you’ve already provided) and they will more than likely reach the same conclusion as they did before.
The danger of the internal appeal is that you can run out your clock on the limitation period in which you can file a lawsuit against your insurer to force them to pay you the benefits you are entitled to. If your limitation period passes, not even the best lawyer can help you then.
Getting A Lawyer Involved With Your Long-Term Disability Claim
Often you cannot get an insurance company to pay your long-term disability benefits without getting a lawyer involved. If you have to hire a lawyer it’s important to have everything ready to get your claim going as quickly as possible. To that end you should request your complete file from your insurance company. They have to provide it to you and it will have all the information a good insurance denial lawyer needs to get your claim started and ensure you get the long-term disability benefits you are entitled to.
Making Sure You Get A Fair Deal
Taylor & Blair LLP has been fighting insurance companies for over 30 years to ensure our clients get the disability benefits they are entitled to. If your long-term disability claim has been denied our insurance denial lawyers will make sure your insurance company pays you what you’re owed.
If you have a claim for denied insurance benefits, contact us today as there are strict timelines in which you have to act.