Long-term disability (LTD) benefits provide financial support when an illness or injury prevents you from working for an extended period. These benefits replace a portion of your income, helping you maintain financial stability during your recovery.
You must typically have LTD insurance through your employer or a private policy to qualify. Eligibility often requires a documented medical condition that severely limits your ability to perform your job duties.
Insufficient Medical Evidence
Your claim must include comprehensive medical documentation. Insurance companies often deny claims due to a lack of detailed evidence supporting the severity of your condition. Avoid potential loopholes and ensure all medical records, physician statements, and test results demonstrate your inability to work.
Failure to Meet Policy Definitions
LTD policies have specific definitions of disability. The insurer may deny your claim if your condition does not match the policy’s criteria. Review your policy carefully to understand what qualifies as a disability and ensure your documentation aligns with these definitions.
Missed Deadlines
Insurance companies impose strict deadlines for filing claims and submitting additional information. Missing these deadlines can lead to automatic denial. To avoid this pitfall, keep track of all important dates and submit your paperwork promptly.
Pre-existing Conditions
Many policies exclude coverage for pre-existing conditions or may impose waiting periods. If your disability stems from a condition that existed before your coverage began, the insurer might deny your claim. Check your policy’s terms regarding pre-existing conditions to understand your coverage limitations.
Lack of Treatment Compliance
Insurance providers expect you to follow prescribed treatments and therapies. If you fail to comply with your doctor’s recommendations, the insurer may view this as non-cooperation and deny your claim. Ensure you adhere to your treatment plan and keep records of your medical appointments.
Is an appeal possible?
If your LTD benefit claim faces denial, you can file an appeal. A legal professional can guide you through the process, helping you gather additional evidence and meet all requirements. An attorney familiar with federal ERISA regulations can help with your appeal to receive the LTD benefits you need.