Applying for disability benefits can be difficult and, after jumping through all of the hoops, your insurance company could outright deny your benefits claim.

Or maybe you were successful in receiving disability benefits for a while, and then the insurance company decides to stop paying you all of a sudden.

LTD denials are common.

Why Was My LTD Claim Denied?

Insurance companies often deny LTD claims, and for a variety of reasons. Some of the reasons for denial include:

• Missed time limit for submitting claim.

• Failure to meet the definition of “totally disabled”.

• Failure to provide enough medical documentation to support your disability or the documentation provided was not detailed enough.

• Misrepresentations on claims forms or other supporting documentation, such as a pre-existing condition that was not mentioned or not fully disclosed.

• Failure to participate in treatment regimen.

• Surveillance evidence contradicting the claimed level of disability.

Or… Why Were My Existing LTD Benefits Terminated?

If you were already receiving LTD benefits, the insurance company can “terminate” or “revoke” LTD benefits that are already being paid out for reasons including:

• Under most disability policies, you are entitled to receive disability payments if you are totally disabled from performing your own job; but, after two years, you must be totally disabled from performing any job in order to continue receiving benefits. That’s harder to prove. Accordingly, the company will often cancel your benefits after the two-year period.

• You breached the terms of the disability policy by not following the treatment plan prescribed by your doctor.

• You breached the terms of the disability policy failing to properly communicate with insurance company or comply with the insurance company’s requests (such as for updates on your condition or additional medical documentation). If, for any reason, your benefits are revoked, you do have the option to appeal or commence a lawsuit against the insurance company to have your benefits reinstated.

It is recommended that you contact a lawyer if this happens.

What Happens If My LTD Claim Has Been Denied or My Benefits Terminated?

Your insurance company will send you a letter explaining that you have been denied LTD benefits, the reason for the denial, and that you are entitled to “appeal” the denial (typically within 60 days).

We strongly recommend contacting an experienced disability lawyer at this stage. There is a limited time frame to file an appeal or start a lawsuit against the insurance company.

That said, your options are to appeal the denial (using the insurance company’s appeal mechanism), or begin a legal claim. There are pros and cons to each.

Appeal

An appeal might be more appropriate where you condition has significantly changed or worsened, or where you have additional medical evidence you can provide the insurance company. Often, with an appeal, the insurance company will put you through a more rigorous screening process for the appeal which may include seeking additional medical assessments, sending you to one of their doctors for an assessment and requesting an excessive number of medical documents from your physician. There may be multiple levels of appeal. Typically, but not always, appealing your denial is unproductive.

Legal Claim

A legal claim might be more appropriate where you remain disabled, your condition has not improved, and you’ve already provided all the documentation you have. Often, a lawsuit can result in faster, better results.

If I Decide to Appeal, What Things Should I Consider?

Should you decide to appeal your denial (or termination) of benefits on your own, some or all of the following steps/processes should be considered:

Compiling relevant documents such as the denial letter, insurance policy, and the insurer’s file.

Determining, with precision, why the insurer denied your application or terminated your benefits, and providing a fulsome, clear response to the insurance company.

Gathering evidence to support your case such as medical records, additional medical tests, written opinions from all of your doctor(s) and written opinions from non-medical experts such as friends, co-workers, family

Considering hiring independent experts such as someone to perform a functional capacity report, vocational expert report or medical expert on your disability.

It is highly recommended that you consult with a lawyer to determine the best option. We offer a free policy analysis and free case review.

Why Should I Consult a Disability Lawyer?

This is an important and difficult time in your life, and an insurance company is not your friend.

Battling an insurance company on your own can be time consuming and emotionally and physically exhausting.

An experienced disability lawyer can help you make informed choices based on his / her years of experience negotiating with insurance companies.

An experienced disability lawyer can do all the heavy lifting for you, and get you the benefits you deserve.

Why Should My Disability Lawyer Also Be an Expert in Employment Law?

More often than not, your policy of insurance is a group insurance policy through your workplace.

If you can’t work because of your disability, then your employment status may be effected.

Time and time again we have seen employment relationships terminate because of a disabled employee’s absence from work or else because of problems that arise after a return to work.

This means that you need an experienced employment lawyer to either help protect your job or else to negotiate a successful resolution based on your departure from the job.

Sometimes, you’ll need to negotiate or bring separate legal claims in respect to your disability matter and employment matter at the same time, and the timing of this is crucial.

Moreover, your policy of insurance may have complicated  “claw backs” provisions, where certain types of payments from your employer (such as severance pay) might be clawed back from benefits you receive.

Most disability lawyers have no (or insufficient) experience in employment law.  But, we are experts in both disability and employment law.

With 100% certainty, you should have a lawyer that is an expert in both disability and employment.

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