When you work hard for your employer, putting in years to help your company succeed, you expect fair treatment if you ever need to use your long-term disability insurance. You and/or your employer have been paying that long-term disability insurance premium for years, and now you are facing, for example, a cancer diagnosis and know you’ll need extended time off.

But what happens if you file a claim for long-term disability payments and are denied? What are you supposed to do?

Long-term disability pay eligibility

First, you should know that most long-term disability insurance policies have requirements for you to receive coverage. Frequently, the requirements include the following:

  • You work for your employer for a specific amount of time before you can receive coverage.
  • You need to work full-time (usually at least 30 hours a week or more).
  • You need to sign up for the long-term disability insurance your employer offers.

Reasons for long-term disability denials

If you are fully eligible for your employer’s long-term disability insurance, the insurance company could still deny your claim. In fact, you shouldn’t be surprised if that happens. Unfortunately, insurance companies work hard to avoid paying long-term disability claims. Some of the reasons for denying your long-term insurance benefits include, but are not limited to, the following:

  • You didn’t provide what the insurance company considers enough documentation of how your illness or injury impacts your ability to work.
  • You didn’t file for long-term disability benefits in the timeline your insurance policy requires.
  • Your policy doesn’t cover your condition – or there is a limitation on your condition.
  • You have a pre-existing condition that impacts your claim.
  • The insurance company is disputing how severe your condition is.
  • The insurance company has you a visit a doctor, who reports you still can work with your disability.
  • The insurance provider disregards the evidence in order to deny or terminate your claim.

If you run into problems getting your long-term disability insurance benefits, you should contact an attorney who is familiar with ERISA.

ERISA protects employees who participate in employer benefit plans, ensuring workers receive the benefits they are entitled to.