An illness or injury has left you unable to work. You do not despair, however, because you have a long-term disability insurance policy through your employer that entitles you to monthly benefits while you can't work. You might think it's simply a matter of filling out a form, but it's never that easy. Despite accepting your premiums for years, the LTD insurance company will do everything they can to avoid paying out on a policy, starting with denying your initial claim if you make even the slightest mistake when filing.
Step One: Review Your Policy Terms Carefully
The most common reason for a claim to be denied is that the policy does not cover the claimant's condition. It's important that you understand the terms of your policy before you submit a claim. Reviewing the policy documents carefully will increase your odds of successfully accessing benefits. If your LTD benefits are provided through your employer, the human resources staff can help you locate the appropriate documents. If your policy was purchased privately, you can call the insurer to request any information you don't already have on file.
Making a note of any application deadlines is an essential part of the review process. Missing deadlines and incomplete paperwork are also common reasons claims are denied.
Complete the Application and Gather Your Supporting Medical Evidence
As you're completing the application, provide as much information about your condition as possible while remaining truthful. Vague information or claims that speak about your limitations in absolute terms will likely trigger a denial. Medical evidence is essential to support a claim for LTD benefits. Be sure to do all of the following:
- Inform your doctor that you wish to apply for LTD benefits. Ask your doctor to write a letter describing how your impairment affects your ability to work. A written letter from your doctor is more helpful than simply completing the forms from your insurance company, as these documents are designed to collect information that can be easily used to deny your claim.
- Request copies of all of your medical records. You will want to include clinical notes, exam reports, lab work, and test results. Make sure you have completed every recommended test or procedure that your care providers believe is appropriate for your condition since a history of inconsistent medical treatment can be used to argue that your disability is not severe enough to qualify for benefits.
- Write a job description. As you are completing the initial application, it is also a good idea to write down your own version of your job description and compare it to what your employer states the position involves. Often, especially at smaller companies, an employee's duties will evolve to include more tasks than he or she was originally hired to perform.
Once your application is as complete as possible, you can submit it to the LTD insurance company.
Communicating With the Claims Adjuster
After your application has been submitted, a claims adjuster will contact you to request additional information and documentation. For example, if you have already applied for Social Security disability benefits, the adjuster may want to know the status of this application.
Note that it is becoming increasingly common for insurers to use video surveillance and unannounced home visits to cast doubt on the severity of a claimant's disability. If you are observed doing an activity that you have claimed you are unable to perform, such as walking long distances or lifting more than 20 pounds, this can invalidate your application.
When in Doubt, Consult an Attorney
Applying for LTD benefits can be a time-consuming and complex process. If you do not understand how to appropriately document your condition or disability, it can make it difficult to complete all of the necessary paperwork. You do not have to go through the process alone. A skilled attorney familiar with ERISA law can help.
The dedicated legal team at Gibbons Law Group, PLLC, has extensive experience handling LTD claims. Contact us today to schedule a free case evaluation.