If you receive long-term disability (LTD) coverage through work, a denial can put your income at risk. It may also threaten the career you spent years building. Physicians who work for hospitals, health systems and medical groups may face denials when insurers fail to recognize how a condition affects their specialized duties.
Why an insurer may deny your LTD claim
An insurer may accept your diagnosis but argue that you can still do your job. Common reasons include:
- Medical records that do not explain what you can no longer do
- Test results that do not seem to match your symptoms
- A broad job description that leaves out fine motor skills, long periods of standing, patient exams or on-call duties
- A reviewer who disagrees with the doctor treating you
The way the plan defines disability also matters. Some plans first ask whether you can do your usual job. Others may later ask whether you can do another type of work.
What to do after receiving a denial
Read the denial letter and identify every reason the insurer provided. Review the LTD policy and summary plan description. This document explains your benefits and appeal rules. Then gather records showing how your condition affects the specific duties your employer requires, such as treatment notes, statements from your doctors, test results and a detailed description of your daily work.
The Employee Retirement Income Security Act, commonly called ERISA, governs many LTD plans offered by private-sector employers. If your employer’s plan falls under ERISA, you have at least 180 days after receiving the denial to submit an appeal to the plan or insurer. Missing that deadline can limit your ability to challenge the decision later.
Build a complete appeal record
Your appeal is often your best opportunity to submit medical opinions, work records and other supporting evidence. After the insurer issues its final decision, a federal court will generally review only the information already included in the claim file. You may not be able to add missing evidence later. Consulting an attorney who handles long-term disability claim denials can help you understand the insurer’s decision, meet critical deadlines and explain how your condition prevents you from performing your specific duties as a physician.