Texas Long-Term Disability Insurance Denials
Texas residents may obtain long-term disability insurance through an employer or purchase coverage on their own, but even when coverage is provided through the workplace, employees often must pay certain amounts to protect themselves from future loss. So, when someone with coverage suffers from a condition that causes long-term disability and the insurer refuses to pay benefits, the denial can cause emotional distress as well as financial hardship.
Fortunately, state and federal laws provide means for addressing Texas long-term disability insurance denials. In many situations, there are several potential avenues of appeal, but they must be approached in a particular order, and the road to obtain benefits may be long and winding. For that reason, many claimants choose to work with an experienced insurance lawyer who understands specifically how to approach their unique claim.
Claims Denied Due to Lack of Evidence
In many cases, claims for long-term disability insurance in Texas are denied because the claimant failed to provide adequate evidence to support the claim of disability. This does not necessarily mean the person seeking benefits is not entitled to those benefits, only that they have not provided enough proof to demonstrate their qualifications.
For a claimant to make sure they have sufficient evidence of the medical condition causing their disability, they should visit the doctor regularly and seek assistance from specialists and physical therapists when appropriate. Doctors should also be ordering tests to confirm disability, the results of which can then serve as evidence.
In addition, because the opinion of doctors is often so important in establishing eligibility for disability benefits, it can be extremely helpful to have a detailed statement from a physician describing how the claimant’s medical condition impairs employment functions. A long-term disability insurance lawyer could request detailed information from a claimant’s doctor or assist in locating a doctor who is prepared to provide detailed information if necessary.
Claims Denied Due to a Finding of Insufficient Disability
In many instances, a person filing for long-term disability benefits in Texas experiences a claim denial because their insurer decided they did not meet the definition of disability applicable to their policy. In all cases, it is important for claimants to be familiar with their policy’s specific definition, so they can determine whether they should be qualified under those terms.
The definitions of disability often vary. For instance, some policies consider a claimant disabled if they are no longer able to perform the particular job they held before, while others require a claimant to be unable to perform any type of gainful work whatsoever. A long-term disability policy may initially define disability one way, and then change to a new definition.
In addition, policies may limit or exclude conditions from the definition of disability. For example, a policy may exclude conditions based primarily on subjective evidence such as reported pain, because they cannot be proven with objective evidence as such as x-rays.
Long-Term Disability Denials Can Be Appealed in Texas
While denial of a long-term disability claim can be discouraging, it is important to remember that denials have become routine for many insurers and that many avenues are available for appeal. However, the means for appealing Texas long term disability insurance denials vary depending on the entity providing the benefits.
While some appeals may involve filing a claim in court, in many cases you must exhaust all administrative remedies before resorting to a lawsuit. A lawyer with experience handling Texas long-term disability insurance denials could assist with every step of the appeal process, even after other efforts have failed to produce desired results.