Long-Term Disability

Long-Term Disability Serious accidents or injuries can happen at any time. But what happens if the insurance company denies your legitimate long-term disability claim?

Look at your policy. Are you covered for “own occupation” or “any occupation”? “Own occupation” coverage means that you are unable to carry out the duties of your current occupation. “Any occupation” is when you are incapable of performing duties of any job. This is a more narrow type of policy that essentially means you are totally disabled. Most insurance policies transition from “own occupation” to “any occupation” after 24 months.

Typical reasons the insurance companies deny your claim is because you don’t have enough medical evidence to support the claim. Medical evidence such as regular medical visits, missing medical records, and a doctor’s statement are important for your claim to be processed efficiently and to your satisfaction. One of the most important pieces of medical evidence you can have is a detailed doctor’s statement. So make sure you obtain your doctor’s opinion on work-related limitations separately from the insurance forms provided.

The insurance company will usually deny your claim if you don’t regularly see your doctor. Long-term injuries require the supervision of your doctor for a long period of time. Don’t stop seeing your doctor, even if you can’t afford it or you may be feeling a little better. You’re sure to get a denial letter in the mail.

The insurance company may also not have all of your medical records. Be diligent—keep track of what records have been ordered and received by the insurance company. This is always a good practice when making and claim, long-term disability or otherwise.

Another reason for denial would be because the insurance company has video evidence that you are not as injured as you say you are. Insurance companies would much rather save paying out for long-term disability; and if hiring a private investigator would help prevent that, they will do it. Social media sites are additional places the insurance company will investigate to look for reasons to deny your claim. A sound bit of advice: act in accordance with your doctor’s restrictions.

You must act fast with your denial appeal, because ERISA (The Employee Retirement Income Security Act of 1974) only gives you 180 days to do so. If you believe your long-term disability claim was denied unfairly, we have over 30 years experience with insurance law. We want to help you get a fair resolution to your long-term disability claim. Please schedule a free confidential consultation by calling us at 704.376.1911 in the Charlotte area or toll free at 1.800.977.3077, or Contact Us online.