Here's what you should do if your Long-term Disability Claim is Denied
Disability insurance is one of the “peace of mind” insurance policies. The purpose of disability insurance is to continue your income stream if you cannot work due to illness or injury. Short-term disability (STD) is usually for a fixed period of 3 to 6 months and often pays your full salary. Long-term disability (LTD) begins after a fixed period of inability to work, frequently the same as the STD period and continues, either for a maximum number of years, or possibly to retirement age. LTD usually pays a percentage of its salary.
There are two ways that your claim can be denied.
If your claim is denied initially, your insurer is taking the position that you are not unable to do the essential tasks of your employment.
If your claim has been paid for a period, and your insurer denies future payment, their position may be that you are sufficiently recovered to return to work.
After the initial period of disability, often two years, many policies change the requirement to qualify as disabled from “unable to complete the essential tasks of your own employment” to “unable to perform any work for which you are suited”. Your insurer may deny your claim, not because you are able to go back to your job, but because you could be doing some other job.
However, if your doctor or other medical professionals have told you that you are unable to work, what should you do?
Documentation - Obtain your own copies of your medical records. You will want to have the supporting documentation submitted with your application for disability insurance. Insurers often require periodic updates of medical records for disability claims. Having your own copies of your medical records can save time when they are needed by medical specialists, or by your legal counsel.
Discussion - Talk to your doctor about your return to work. Make sure your doctor understands what your employment responsibilities are, and why you cannot do them. The more specific your doctor’s recommendations are, the clearer the evidence for the insurer. If your doctor believes that any of your job-related tasks would impede or delay your recovery, they should address this in their written notes to your employer.
Decision - Insurers often have several levels of processes for review and reconsideration of the decision to deny or terminate a disability claim. You do not have to wait for the decision to be final to obtain legal advice as to your options.
Most importantly, make sure you have professionals on your side who are experts in the disability insurance process and who will support you and work with you to ensure you understand your options, and to do what is best for you. The dedicated lawyers at Singer Kwinter have developed an expertise in understanding the complexities of insurance disputes.
