You hoped you would never need to use it, but having a long-term disability (LTD) insurance policy gave you peace of mind that you would be taken care of if you became unable to work because of an injury or illness. However, you are now shocked to discover that your LTD claim has been denied. How could this happen? Shouldn’t you be covered?

Unfortunately, insurance companies do not want to pay on these claims and will do anything in their power to deny your application for benefits. In fact, it is not uncommon for people to have to go through multiple levels of appeal to fight for the benefits they deserve. You don’t have to go through this process alone, however, and we highly recommend that you don’t. At Gibbons Leis, PLLC, our attorneys are here to help with your LTD appeal to give you the advantage you need when fighting an insurance company that simply does not want to pay your claim.

ERISA vs. Individual LTD Policies

Your LTD policy may be provided by your employer, or you may have purchased it individually.  Employer-provided policies are governed by a federal law known as the Employee Retirement Income Security Act (ERISA), and the appeals process is much more complicated than it is for individual policies. Deadlines are short and strict, and you will have to go through an internal appeal process with the insurance company before you can file a lawsuit. With ERISA policies, new evidence can only be presented during the administrative appeal process, not at trial, so you must be diligent about gathering and presenting evidence while you can. ERISA appeals are very difficult to handle without an attorney. For your best chance of success, call Gibbons Leis, PLLC to discuss your options.

There are more options available to those appealing private LTD insurance denials. In fact, claimants may have more rights because these plans are governed by applicable state laws instead of ERISA. We are available to help when these claims are denied as well, and our team can help you set up your case for a good result.

Why LTD Claims Are Denied

Insurance companies deny LTD claims for a variety of reasons, some of which are unfair and illegal. Some of the most common reasons for claim denials include the following:

  • Insufficient medical evidence. You will have to paint as complete a picture as possible of your injury or illness, including a history of regular doctor visits, proof of participation in recommended treatments, comprehensive medical records, and detailed statements from your doctor confirming that you are unable to work. If the insurance company does not have all of this evidence when you initially apply, they will likely deny your claim. Our attorneys will make sure you have complete medical evidence when you appeal the denial.
  • Failure to meet the definition of disabled. The insurance company will try to claim that you are not actually disabled according to the terms of your policy, which may exclude certain conditions from coverage and require you to change professions in order to find work you can do. We can make sure you have a proper diagnosis of your condition and that your physical or psychological limitations are documented and verified by a doctor and vocational expert.
  • Conflicting evidence. The insurance company may hire someone to follow you, videotape you engaging in various activities, and monitor your social media activity to try to catch you doing things they believe are inconsistent with your disability claim. Our attorneys will advise you on how to protect yourself from such intrusion and will provide counter-evidence to support your claim whenever possible.
  • Missed deadlines. From the day your claim is denied, you must act quickly to gather evidence and file an appeal. If you miss a deadline, you will lose your opportunity to appeal and to file suit. It is vital that you get an attorney on board as soon as you get notice of denial so that all deadlines are met.

There are many other reasons insurance companies will use to deny your claim, but when you work with Gibbons Leis, PLLC, you can be sure we are prepared to handle anything they throw at us.

Call Us Today

You are relying on your LTD insurance to provide the support you need after a serious injury or illness. In Charlotte, the long-term disability attorneys at Gibbons Leis, PLLC are available to build a strong appeal and give you the best chance of success. Give us a call at 704-879-3841 or fill out the contact form on this page to see how we can help you.