What to Do If Your Long-Term Disability Claim Is Denied
Long-term disability insurance provides essential income when, due to illness or injury, one is no longer capable of working. However, for so many policyholders, there's one infuriating situation in which LTD claims get denied-even when a claimant feels they meet all the criteria. In that respect, the most vital thing you can do in case your long-term disability claim is denied is to take action straight away. The following are what you can do to fight against the denial and ensure that you get what you deserve.
Read the Denial Letter Carefully
If your claim for long-term disability has been denied, the first thing to do is to read and re-read the denial letter your insurance company writes. It will contain relevant information about the reason your claim was denied, anything from a simple "not enough medical documentation" to their belief that you did not meet the "disability" definition as outlined in the policy. It will also be a way to know what the denials are for, precisely, which will help in further process.
Clearly understand the policy conditions, the reasons for denial according to the insurer, and any specific timeframe within which the appeal should be filed. Sometimes the insurer gives instructions on how the decision can be contested.
Obtain More Medical Records
One of the easiest bases upon which LTD claims are denied is lack of sufficient medical evidence to substantiate your claim. Should your original claim have been initially denied based upon a lack of medical evidence to substantiate your claim, you will want to obtain more comprehensive evidence from your medical providers. Copies of medical records, treatment plans, and letters from doctors specific about how your condition affects your ability to work.
That it will be helpful in many instances for the medical professional treating you to provide a more thorough appraisal or opinion, further substantiating your claim of disability, should the insurer take the position that your medical condition fails to meet the threshold requirement for disability benefits. Also, bear in mind that often, the carriers will rely on their own internal medical examiners, so positive independent evidence from your doctors will be most important.
Appeal the Denial
If a claim has been denied, most insurance plans have an appeals process. This is one case in which a person should act as quickly as possible, since there are many tight deadlines to file an appeal-usually between 30 to 180 days after the denial letter was received.
Any new medical documentation with your appeal is very helpful as well as any other evidence to support your case. Other examples include witness statements of coworkers, employers or others that can testify to the limitations that your disability imposes upon your capabilities to work. It also should be as neatly prepared as possible and include all requested forms or information requested.
Seek Legal Representation
Seeking the help of a LTD lawyer can increase your chances of success in case your initial appeal is unsuccessful, or if you are not sure how to proceed. A disability attorney will know the intricacies of an LTD claim and thus lead you through the appeals process. They also can help in collecting the necessary evidence, negotiating with the insurer, and representing your interests in court in case the appeal fails.
An experienced attorney can detect weak points in the insurer's denial and may be able to assist in the presentation of your appeal in the most robust manner possible. Should the matter proceed to trial, the counsel will be imperative in making arguments to the court.
Avail of Alternative Dispute Resolution Methods
Sometimes it may be advisable to resort to some alternative dispute resolution process. Sometimes mediation or arbitration can result in more rapid and satisfactory disposal of your claims than can litigation. The ADR processes are neutral third-party devices to assist in arriving at a settlement between you and the insurance company without having to go through a trial. Discuss this option with your attorney to see if it applies to your case.
Know Your Legal Rights
When appealing against a denied LTD claim, it's important to know one's legal right. Usually, the law forces an insurance company to make decisions that must be justifiable, transparent, and based on adequate evidence. If you feel that your insurer has acted in bad faith-that is, intentionally misinterpreting the conditions of the policy or not taking up the claim with due diligence-you have other grounds for a suit rather than an appeal.
An attorney can analyze any bad faith case you might have before you institute any action and advise you accordingly.
Persistence and Organization
Lastly, be patient and stay organized. In working with an insurer, you'll be making telephone calls, writing emails, and mailing letters, which will be documented. Keep track of dates related to deadlines so that you can follow through on appeal or litigation requirements. This recorded history may prove very helpful if your case goes to court or further review.
Conclusion
Having a claim denied for long-term disability is not assuring; however, it is not the end of the world. You can make a self-determination of charge by reading the denial letter carefully, marshaling more evidence, filing an effective appeal, seeking services of a lawyer, and knowing your rights. Whether you appeal or litigate, the right support with correct information basically helps one to go through the process with success and have one's disability benefits reinstated.