Although the purpose of Long-Term Disability (LTD) Insurance is to provide benefits to disabled individuals who are unable to work for an extended period of time, insurance companies commonly deny most initial claims, even those with merit. While insurers have wide latitude to deny claims, an experienced disability attorney can help you obtain the benefits you deserve by helping you through the long-term disability appeals process.
Roeschke Law, LLC is the premier disability benefits law firm serving clients in Phoenix, Tucson and throughout the state of Arizona. We are well versed in the ERISA rules applicable to LTD insurance and have a proven track record of pursuing successful LTD appeals.
Why Are Long-Term Disability Claims Denied?
Although each claim is unique and insurers base their decisions on the provisions of the plan, some of the common reasons for denials include:
- The disability does not meet the plan’s requirements
- Insufficient or inadequate medical records
- The claimant has a pre-existing medical condition
The Long-Term Disability Appeals Process
If your LTD insurance claim has been denied, you must act quickly. If the plan is governed by ERISA, you have 180 days from the receipt of the initial denial letter to file an appeal. Claims under different benefit programs have different time limits, however. In any event, it is imperative to contact our experienced Arizona LTD appeals attorneys so that you do not miss these deadlines.
Our legal team will promptly review your claim to determine the reason for the denial and begin collecting evidence that forms the basis of your appeal, including:
- Medical Evidence – In addition to gathering all of your medical records, we will work with your doctor and other medical professionals treating you, including physical therapists, chiropractors, and other specialists, to prepare letters explaining how your disability affects you and prevents you from performing your job or any other work. Ultimately, providing more tests and medical evidence to the insurance company will improve your chances of obtaining benefits.
- Vocational Experts – In some cases, claims are denied because claims adjusters are not familiar with certain occupations or the nature of the work involved. If necessary, we will obtain a written letter or testimony from a vocational expert who can attest to the physical and mental demands of your work.
Other Disability Benefits – Being enrolled for other disability benefits such as SSDI or SSI can serve as strong evidence of your disability and support your claim. If the appeal is denied, receiving public benefits can also act as evidence in the event a lawsuit becomes necessary.
- Personal Statements – Obtaining statements from people who know you, such as family members, friends, former coworkers and others who have witnessed how your disability affects you can also serve to support your claim.
The Insurance Company’s Response
The insurance company has 45 days from the date the appeal is received to respond. The insurer can reverse its decision, deny the claim for a second time, or notify you that it needs an additional 45 days to reach a decision. In any event, the insurer must make a decision within 90 days. If the insurance company fails to meet these deadlines, we may recommend filing a lawsuit.
If the insurance company denies the first appeal, under ERISA, you are required to make additional internal appeals. There are deadlines for filing these appeals, and missing them means that you will be barred from receiving benefits. Moreover, you must exhaust all of the administrative remedies under your plan, before you can file a lawsuit.
Pursuing A Lawsuit
After the internal appeals process has been exhausted, you may be able to pursue a lawsuit under ERISA, however, the time limit to file a lawsuit may be governed by your insurance policy. Also, once the administrative appeals process has ended, the record in your case is closed, and the court will only consider evidence that was included in your claim file and no additional evidence can be submitted. It is also possible to pursue a lawsuit under state law for claims under other long-term insurance plans.
Call Our Arizona Long-Term Disability Appeals Attorney
Even though you may be covered by long-term disability insurance, there is no guarantee that you will receive the full value of your claim, and it is highly likely that your claim will be denied. Let’s face it: insurance companies often put profits ahead of the needs of the policyholders. Armed with powerful teams of attorneys and claims adjusters, insurers have an unfair advantage over the disabled.
At Roeschke Law, we have the skills and resources that are necessary to level the playing field. We will design a well thought out appeal that presents a strong case so that the insurance company will reverse its initial decision and approve the claim. If the insurer denies the claim, it is essential to “stack the record” during the appeals process so that you have a solid claim if we decide to pursue a lawsuit.
Our guiding principle is to help our clients obtain the benefits they deserve to cover their medical expenses, lost wages, and day-to-day living expenses. We believe that no one should be denied the long-term disability benefits they have earned, and we will fight to protect your rights. Call our office today at (800)975-1866 or complete the contact form on our website.