Long-term disability insurance is designed to provide benefits to disabled workers who are unable to perform their job for an extended period of time. Nonetheless, insurance companies typically deny most initial claims, which means it may be necessary to file an appeal. By enlisting the services of Roeschke Law, LLC, you can obtain the benefits you deserve. Our long-term disability attorneys are knowledgeable in the rules under the Employee Retirement Income Security Act (ERISA). We have decades of experience advocating for the disabled in Phoenix, Tucson and throughout the state of Arizona.
Reasons Long-Term Disability Claims Are Denied
Under ERISA, claims administrators that work for your insurance company are authorized to evaluate disability benefits applications. This potential conflict of interest may explain why claims are routinely denied, even those that have merit. Although claims may be denied for any number of reasons some of the most common are as follows.
Insufficient Medical Evidence
Completing a long-term disability benefits application can be complicated because it must include extensive medical records substantiating your claim. In addition, you must provide evidence that you have been receiving medical treatment regularly in order for your claim to prevail. This means that you have been making visits to your primary care physician, as well as specialists, at regular intervals for treatment of a physical condition. Your doctors must also be administering objective tests such as X-rays, MRIs and CT scans as needed. Similarly, if you have been diagnosed with a psychiatric disorder, such as depression, you must be seeing a psychiatrist or a psychologists at least monthly.
Failure To Meet The Policy’s Definition of Disability
Disability benefits policies typically include the definition of disability in the summary plan description. This definition depends on the type of LTD policy — either “own occupation” or “any occupation.” Under their own occupation policy, a person who cannot carry out the duties of his or her particular occupation is considered disabled. On the other hand, any occupation policies define disability as the inability to carry out the duties of any job. In addition, the policy summary plan may specify excluded conditions. Among these are medical treatments for substance abuse or pre-existing conditions. Finally, benefits for conditions that are based on subjective complaints, rather than objective analysis, such as depression, chronic fatigue syndrome, or fibromyalgia, may be limited to 24 months.
Missing Medical Evidence
LTD disability claims can be denied due to insufficient medical evidence, either because the application was not completed correctly or because the insurance company failed to obtain all of the medical records. Under these circumstances, you should obtain a list of all the records your disability carrier has requested and those it has received. If records are missing, or the insurer did not request the records, they should be provided as soon as possible.
The opinion of your treating physician will weigh heavily in the approval of your disability benefits application. Often times insurance companies ask doctors to complete forms that are designed to elicit responses that will lead to a denial of your claim. Therefore, it is crucial for your doctor to provide a written opinion detailing precisely how your condition limits your work abilities.
It is important to be aware of any deadlines for filing and appealing claims. Under ERISA, most individual and group plans give you 180 days to appeal an initial denial. During this time, the LTD attorneys at Roeschke Law can help you gather medical records and other documentation to stack the administrative record with supporting evidence. By missing the 180-day deadline, you may forfeit your right to file a lawsuit against the insurer in federal court.
Moreover, once you initiate the appeals process, it is crucial to submit complete medical records to your insurance company as soon as possible. If doctor’s reports, third-party statements, and other favorable evidence are not contained in the administrative record, the information cannot be introduced in court.
Call Our Arizona Long-Term Disability Benefits Attorney
As you can see, there are numerous reasons why long-term disability benefits applications are denied. This is why having an experienced LTD attorney on your side is essential. At Roeschke Law, we know that some insurance companies are more concerned with profits than the well being of the disabled. Our experienced LTD attorneys are highly regarded for being dedicated advocates of the disability.
We have extensive experience filing disability benefits claims and appeals and a proven track record of helping our clients obtain the benefits they deserve. If you need assistance applying for long-term disability benefits or filing an appeal, we can help. We handle all LTD cases on a contingency basis which means that you will not pay any attorneys fees until we win your case. Get in touch with us today by calling the office at (800)975-1866 or completing the convenient contact form on our website.