Have you become injured and unable to perform your duties at work as a result? Did you apply for long term disability coverage through your insurance company only to be denied? What steps can you take from here? First, it is important to understand why your claim for long term disability may have been denied.
Your injury may not satisfy the insurance definition of “disabled”
Every insurance policy is different, especially policies that are intended to cover large bodies of people, such as a policy used by a workplace to insure their employees. Two common types of policies are “own occupation,” which define a disability by being medically unable to carry out the responsibilities of your specific job. “Any occupation” defines a disability as the medical inability to perform any job.
Certain policies carry certain exclusions as well. Pre-existing conditions are often excluded from long term disability coverage, and other disabilities that rely on diagnoses that aren’t quantifiable by proof – such as certain mental conditions – may only provide coverage for a limited amount of time.
You may not have provided enough evidence to prove your disability
To be granted long term disability benefits you must be able to prove that the benefits are essential to your continued livelihood. You must prove that the benefits will go towards necessary, continuous medical treatment. To do this, you must supply the insurance company with accurate, up-to-date medical records, such as test results.
Further, whether or not you receive benefits can hinge on a written statement of opinion from your physician. This statement should include all the medical reasons for why your disability impacts your ability to work, and how performing those duties would potentially cause you harm.
Appealing a denial
If you were denied a claim for long term disability but feel as though it was a wrongful denial, you may appeal the decision. You should review the insurance company’s long term disability police first and foremost, to make sure you didn’t miss a crucial element when submitting your claim. You can usually obtain a copy of the policy from your human resource department or from the insurer itself. Your right to obtain a copy of the policy is protected by federal law, so do not take no for an answer!
Look over the denial letter for the reason you were denied coverage. You may have missed important information or forgot to supply a key piece of information, like the opinion statement from your doctor. You should also hire an attorney at this point, who will help you organize your appeal. Additionally, hiring an attorney will show the insurance company that you mean business, and will not go away without a fight.
Working with an attorney, you may find that you have a limited time to appeal a decision, and therefore limited time to obtain any medical records, or undergo any additional necessary tests to prove the difficulties caused by your disability.
As with any case involving legal affairs, it is essential that you are working with consummate professionals who understand the law and treat your individual case with special care and attention. That is exactly the type of counsel we provide at Altman & Altman LLP.
We have over 40 years of experience advocating on behalf of normal, everyday working people, helping them stand up to employers, insurance companies and anybody else who may have contributed to them being wronged. We will work tirelessly to fight for you, and will tailor a specialized strategy to ensure the highest potential for success.
Call us for a free consultation today at 617-492-3000 or toll-free at 800-481-6199. We are available 24/7. We do not collect a single cent unless you are successful in a claim.