1. Why are long-term disability claims commonly denied for medical professionals?

Insurance companies frequently deny claims by arguing that:

  • Your medical records don’t prove total disability.
  • You could still perform “some other occupation” even if you can’t treat patients.
  • Independent medical examiners or surveillance suggest you can still work.
  • There were errors or omissions in your paperwork.

Because medical professionals often carry own-occupation policies, insurers sometimes misinterpret or misapply that definition to avoid paying benefits.

2. What is an “own-occupation” policy, and why is it important?

An own-occupation policy pays benefits if you are unable to perform the primary duties of your specific profession. For medical professionals, that means if you cannot safely perform hands-on clinical work—even if you could theoretically work in another capacity—you may still qualify as disabled. Insurers often challenge this distinction, making legal representation critical.

3. What should I do if my LTD claim is denied?

  • Read the denial letter carefully. It will explain why the insurer rejected your claim.
  • Request your claim file. Under ERISA, you have a right to see what evidence the insurer used.
  • Gather medical evidence. Ask your providers for detailed notes supporting your disability.
  • Contact a disability attorney. Appeals under ERISA must follow strict procedures, and missing steps could permanently harm your case.

4. How long do I have to appeal a denied claim?

Most ERISA-governed LTD policies give you 180 days (about six months) to file an appeal. Missing this deadline usually means losing your right to challenge the denial in court later. Acting quickly is essential.

5. What evidence helps strengthen my appeal?

Strong appeals include:

  • Comprehensive medical records and test results.
  • Physician statements explaining why you cannot perform your professional duties.
  • Vocational expert reports showing the physical and cognitive demands of your specific medical role.
  • Documentation of lost income or the impact on your ability to practice.

6. Can I still work in some capacity and receive LTD benefits?

Yes—if you have an own-occupation policy. For example, a surgeon with hand tremors may be unable to operate but could still teach or consult. Under an own-occupation definition, they may still qualify as disabled. However, under “any occupation” policies, insurers may deny benefits if you can work in any role.

7. Do I need a lawyer to appeal my LTD denial?

While not legally required, having an attorney who specializes in LTD and ERISA claims is highly recommended. Insurance companies have their own legal teams. A knowledgeable disability lawyer can:

  • Ensure all necessary evidence is submitted during the appeal.
  • Challenge biased insurance company exams.
  • Protect your rights if the case goes to federal court.

8. What happens if my appeal is denied?

If the appeal is denied under ERISA, you may file a lawsuit in federal court. However, courts usually only consider the evidence already in your claim file, which is why it’s crucial to build a strong record during the appeal process.

9. Will pursuing a claim harm my medical license or professional reputation?

No. Filing for disability benefits is a contractual right under your policy. Insurers may investigate your claim, but asserting your rights will not jeopardize your license or standing as a medical professional.

10. What sets medical professionals apart in LTD claims?

Doctors, dentists, and other medical professionals rely on specialized skills that often cannot be substituted. A disability that limits dexterity, vision, or stamina may not affect other jobs but directly prevents safe patient care. Insurers often overlook this distinction—making it essential to have an advocate who understands both the medical and legal aspects of your profession.

More Important Facts:

  • Over 60% of long-term disability claims are initially denied by insurers. Many are later overturned on appeal when handled correctly.
  • Medical professionals (like dentists, surgeons, and physicians) are 2x more likely to file an LTD claim due to repetitive strain injuries and musculoskeletal disorders.
  • Insurers frequently dispute own-occupation policies, arguing that a doctor or dentist could work in an “alternative role,” even when they can no longer treat patients safely.
  • Under ERISA, you usually have only 180 days to appeal a denial—miss this deadline, and you may lose your rights permanently.

Most LTD attorneys, including firms like Uscher, Quiat, Uscher & Russo, P.C., work on a contingency basis—you don’t pay unless they win your case.