ERISA Experience You Can Rely On.

Top 4 reasons that long-term disability claims are denied

On Behalf of | Feb 2, 2023 | Long Term Disability Claim Denial

Few things are as stressful as suffering a debilitating injury or illness that prevents you from performing your job duties and earning a living. If your employer offers long-term disability (LTD) benefits and your condition is covered, you should be eligible for benefits.

However, claims are handled by administrators who work for the company’s insurance carrier. Since it’s their goal to minimize payout of money, claims are often denied. Fortunately, the Employee Retirement Income Security Act (ERISA) oversees insurer decisions, and you can appeal.

Avoid these errors when filing a claim

Insurers often reject claims for bogus reasons, but sometimes denial is unsurprising based on mistakes by a claimant. Here are the most common errors:

  • Not meeting policy guidelines: Check your employer’s plan to see if your condition is covered and that you meet their definition of “disabled.” Some policies contain exclusions. Also, check the plan summary to know if it’s an “own occupation” or “any occupation” policy, which can determine when you become eligible for LTD benefits.
  • Lack of medical evidence: Claims are often denied due to missing or incomplete medical documentation or because a patient misses regular medical appointments for treatment. Follow your doctor’s plan “to a T” and include all scans and other relevant tests in the claim. Also, ask your physician for a detailed statement outlining your condition.
  • Missing deadlines: The insurer will outline the appeals process and deadline for a rejected claim. Under ERISA-governed plans, you typically have 180 days. If you haven’t already talked to an experienced attorney, it’s advisable to do so before filing the appeal.
  • Surveillance discrepancies: Insurers often hire investigators or check your social media accounts for any sign that your condition is not legitimate. If you cannot work due to a bad back but post pictures of yourself on Facebook playing hoops or even doing light yard work, expect a denial.

You are not alone

Insurance companies put their own interests first and usually don’t face repercussions for wrongly denying benefits. The appeals process only adds to the stress if you can’t work and your bills keep mounting. That’s where an attorney’s advice can be crucial from the get-go or when appealing a denial. ERISA lawyers understand how employer LTD plans work, the type of evidence the insurance company requires and how to best represent you when appealing a rejected claim.