Getting denied for long term disability (LTD) benefits can be a devastating experience. However, just because your initial claim was denied by your insurance company, doesn’t mean that you are out of options. In Texas, anyone who receives a long term disability denial has the right to appeal that decision. And because the appeal is evaluated by a different branch within the company, you still have a reasonable chance of getting approved in the future.
If you have recently been denied LTD benefits, try not to get too discouraged. Your initial long term disability denial is definitely not the end of the road for your quest to receive the benefits that you deserve.
Why was Your Long-Term Disability Claim Denied?
If your claim for LTD has been denied, the insurance company will send you a letter to inform you of their decision. Make sure to read the letter thoroughly as it will also list the reasons why you have been denied. Before you begin to think about appealing the insurance company’s decision, you first need to know why you received a long-term disability denial.
Some of the reasons why an insurance company may deny your claim could include:
- The insurance company has evidence that you have engaged in activities that you claimed you were not physically able to do.
- Your disability was self-diagnosed
- There is not enough evidence to prove your disability
- The Insurance company consults with a physician that disagrees with your doctor
In many cases, the insurance company will deny your initial claim because they do not have enough information that proves you are disabled. If that is the case, you will need to contact your doctor and get a copy of any scans, X-rays, or tests that pertain to your condition.
You should also request a copy of your claim file and a copy of your policy. The claim file will include all of the information that the insurance company took into consideration to reach a decision about your case. Once you have gathered all of the missing information, you can submit the new information to the insurance company when you file your appeal.
How Long do I Have to File an Appeal?
Your denial letter should give you all of the information on how to file an appeal. The letter will also specify how long you have to file the appeal. In most cases, you will have 180 days to appeal the decision. However, some policies will give you a little more time. Be sure that you read the letter carefully and understand exactly how much time you have to file the appeal. If you wait too long you will forfeit your right to an appeal.
The Difference Between Group and Individual Long-Term Disability Plans
Long-term disability can be acquired one of two ways: By having a group plan offered by your employer, or having an individual plan that you purchased by yourself.
Group LTD Plans
Group plans are usually covered by the Employment Retirement Income Security Act (ERISA) and require that you follow certain rules after you are denied. With ERISA plans, you must first exhaust all of the appeals processes that are defined in your policy before you can file a lawsuit against the insurance company.
Also, you will usually only have access to your group LTD benefits if you are still working for the company that offered it to you. For example, if your job offers long-term disability insurance and you decide to quit that job before you became disabled, there is a good chance that your relationship with the insurance company ended the same day that your relationship with your former employer ended.
Individual LTD Plans
On average, individual plans are often more expensive than group plans. However, you are not usually required to exhaust the appeals processes before filing a lawsuit. Also, as long as you are up to date on your payments, your individual LTD will stay with you when you leave one employer and go to another.
How to Improve Your Chances of Winning your Appeal?
In addition to submitting x-rays and test results with your appeal, there are a few other things that you can give to the insurance company to help improve your chances of getting your claim accepted.
First, you can ask your employer and co-workers to write a letter on your behalf. Ask them to make sure that they include specific times that they witnessed you struggling to do your job because of your condition. If your employer is not willing to write a letter, see if you can get a copy of your performance reviews. If the reviews show that you were able to perform your job well in the past and have recently started having trouble completing your tasks, that could help to prove that your condition is causing you the inability to do your job.
It is also a good idea to submit a letter from your doctor. If you see multiple doctors for your condition, be sure to ask each doctor to write a detailed letter explaining your conditions and the reasons why they think that you may be unable to work efficiently.
Need Help Filing Your Long-Term Disability Appeal?
Another way to help improve your chances of getting your LTD claim accepted is by hiring an experienced lawyer. While you can file your appeal on your own, hiring a long-term disability lawyer that has extensive experience with dealing with insurance companies will give you the best chances of winning your case. They will be able to walk you through the process and will know exactly what it takes to get your LTD claim accepted.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts