Long-Term Disability Claim Denied
If you had a long-term disability claim denied by your insurance company, you need to file an appeal quickly. Appeals require additional information and medical documentation that can be complicated to obtain. Our experienced attorneys at Uscher, Quiat, Uscher & Russo, P.C., can guide you through the appeals process and make sure you get the compensation you deserve.
Why Was Your Long-Term Disability Claim Denied?
When you make a long-term disability claim, you will submit medical evidence and information about your income. You will need to complete all of your insurance company’s required documentation and provide adequate evidence of your illness, injury or accident. Even if you believe your claim of disability is clear, your long-term disability insurance company may deny your claim.
Common reasons for denial of a long-term disability claim include the following:
- Insufficient Medical Evidence: You must submit medical records that evidence regular medical treatment for your illness, injury or accident. Medical evidence must include medical records as well as the doctor’s statements. If you do not provide medical records showing consistent treatment over a period of time, your claim may be denied.
- Failure To Meet The Definition Of Disability: Your insurance company will have a specific definition of disability. It likely involves the impact on your activities of daily living, such as socialization and self-care. It also requires that you’re unable to complete the duties of your job or any job. If you do not provide evidence and medical opinions that show you’re disabled according to your insurance policy’s definition of disability, you may be denied.
- Evidence Inconsistent With Disability Claim: In large claims of long-term disability, the insurance company will conduct an independent investigation and obtain evidence such as medical opinions and video surveillance. If any of that evidence is contrary to your claims, you may have your long-term disability claim denied.
- Your Claim Is Subjective: Although you should be able to make a disability claim for conditions such as depression, fibromyalgia and chronic fatigue syndrome, most of the medical evidence for such claims is subjective. Pain and fatigue are difficult to prove. If you lack objective evidence, which can easily be seen on medical tests, your claim may be denied.
- Missed Deadlines: Every long-term disability insurance policy imposes deadlines for making claims and submitting evidence. If you miss any of those deadlines, you may have your long-term disability claim denied. It’s important to note that the insurance company must legally meet deadlines as well.
If your long-term disability claim is denied, you should immediately seek the assistance of an experienced attorney to help you with the appeals process. We will evaluate the insurance company’s reasons for denial and make sure we obtain evidence that combats their claims. We will evaluate your policy’s definition of disability and find precise evidence that matches categorical definitions of disability.
How To Avoid Common Mistakes In Long-Term Disability Claims
If you had your long-term disability claim denied, you likely have many questions. We can help you find answers. Avoid common mistakes in long-term disability claims with the following:
- Seek Expert Opinions: Although you have a primary care physician and may have several specialists, you may need to seek an independent medical opinion. The insurance company may also request that you obtain an outside opinion. By obtaining both a functional capacity evaluation report and a vocational expert report, you can prove that you meet the definition of disability.
- Meet Appeal Deadlines: If your claim is denied, you have a right to appeal. Under most long-term disability insurance policies, you have 180 days to gather additional evidence and then submit an appeal. You should take that time to obtain solid evidence of disability and seek legal advice to make sure you meet the insurance company’s requirements.
- Order The Insurance File: You have a right to review the information contained in the insurance company’s file. This will allow you to understand where they lack information.
- Talk To Your Doctor About Your Long-Term Disability Claim: Your primary care doctor and specialists should be on your side when you’re making a long-term disability claim. Talk to them before asking them to complete insurance documents. If they are not supportive, you may need to transfer your care.
- Find A Long-Term Disability Attorney: The long-term disability claims and appeals processes can be legally complex, especially under ERISA. An attorney with experience working with both insurance companies and medical providers can give you an advantage.
Legal Assistance After You Have A Long-Term Disability Claim Denied
If your long-term disability claim was denied, you need to submit an appeal as soon as possible to meet the necessary deadlines. Along with that appeal, you should submit additional medical evidence, expert opinions and independent medical evaluations. An experienced attorney from Uscher, Quiat, Uscher & Russo, P.C., can help. If you had a long-term disability claim denied, call us at 201-781-5645 or send an email to get in touch.