Why Your Long-Term Disability Claim May Be Denied
Long-Term Disability (LTD) insurance has the purpose of protecting you financially if you cannot work due to an injury or illness. Unfortunately, many LTD claims are rejected by the insurer. If you are considering whether to dispute the denial, consider speaking to Littlejohn Barristers, your Barrie personal injury lawyers to assess your case. Some common reasons for denial of claims are provided here below.
Insufficient Evidence to Support the Claim
Rejection letters often say there is insufficient evidence of the disability. It could be that the insurer is seeking supporting evidence (e.g., clinic notes, lab results, x-rays, surgical reports) to verify the doctor’s diagnosis. Or, it could be that your doctor failed to describe exactly how the injury or illness impacts your daily activities with wording that the insurer can verify according to their guidelines.
You will want your lawyer to review the policy in the event that your insurer requests “objective evidence,” to make sure this is required. Your insurer may reconsider the claim once they have determined they have sufficient evidence.
Error(s) In Submitting the Claim
Another reason for rejection of an LTD claim may be an application error, whether the matter is clerical, procedural or a missed deadline. It may be possible to resubmit the claim with the correction needed for approval. If you were late in submitting or resubmitting the claim, you may need to provide a valid reason for the delay.
Not Meeting the Disability Definition
Probably the most common reason for being refused LTD benefits is not meeting the definition of disability and so the insurer believes that you are not totally disabled. It is very important to read the policy as the definition of disability can vary between insurance companies and between insurance plans at the same company.
Typically, you must be medically unable to work at your own occupation up to the first two years of your disability, after which you must be medically unable to perform the essential duties of any occupation for which you are reasonably qualified by training, education or experience. If your employer is willing to provide accommodations and shorter hours or retrain you, your insurer may view that you can perform work available to you.
It is best to read over the policy very carefully as a policy exclusion may apply, such as for particular diseases or workplace accidents. Additionally, many LTD policies have a 24 month limit on disabilities caused in part by alcoholism, drug abuse or mental or nervous conditions.
Sometimes, an exclusion relates to the illness itself or a reason for the illness, such as a pre-existing condition that was diagnosed and/or treated (often 90 or 180 days) before the disability. Fortunately, disability policies do not always exclude pre-existing conditions and instead may have language about coverage for an unexpected re-occurrence or aggravation of a condition. It is best to have your LTD lawyer review your situation against the policy terms. Your lawyer may be able to get the insurer to reconsider denial of the claim.
Failing to Comply With Assessment &/or Treatment
Your LTD benefits could be discontinued if you fail to follow the treatment recommendations of your medical provider. If you find that a treatment is not working, you must consult with your doctor instead of discontinuing the treatment on your own. You must also comply with any assessment requirements, such as undergoing an independent medical exam if the insurer arranges one for you. Finally, you must also take part in rehabilitation program if the policy requires it. Otherwise, your benefits could be terminated early.
Not Qualifying Due to Contractual Limitations
It is a sad reality that you may be excluded from the policy if you don’t meet the criteria for the insurance. For example, you might not have met the eligibility period as an employee or have not yet worked the minimum hours of work needed to qualify. Also, when you reach age 65, your LTD benefits could end.
Insurers are increasingly vigilant about ensuring that they pay disability benefits to eligible claimants. If there is any contradictory evidence about your LTD claim (e.g., exaggerating injuries, misrepresentation on the application), your credibility may be undermined, and your claim may be immediately terminated. You could also be asked to repay the benefits you received.
Traditionally, video surveillance of public activities was used as contradictory evidence by the insurer, but now social media posts, including Facebook, Twitter and Instagram are also being scoured to point out inconsistencies. As an example, your reputation may be under attack if you claim be ongoingly depressed about your chronic pain, but then post photos of you having a good time on vacation.
Contradictory evidence can also include the insurer’s reliance an “independent” medical examiner’s report which states that you can work, at least partially. Unfortunately, you must attend these exams in order to receive your benefits.
Speak to Littlejohn Barristers about Benefits If You Have a Long-Term Disability in Barrie
At Littlejohn Barristers, Barrie personal injury lawyers, we can provide you with a free consultation about your LTD claim. If you are ready to submit a claim, we can review the forms and submit them on your behalf. If you have received a rejection letter, we can assess the matter to help you determine the next steps. In some situations, a denied claim can be easily resolved and, in other situations, you may consider contesting the decision. Usually the matter is about getting the benefits you deserve, though sometimes the issue is an insurer acting in bad faith. At our Barrie law firm, we have extensive experience with LTD claims. Contact us at 705-725-7355.