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How to Appeal Long-Term Disability Denials

If you’ve suffered an injury that has sidelined you for a considerable length of time, you might be eligible to file a long-term disability claim. Unfortunately, these claims can be quite complex and are often denied by the insurance company involved. Read on for more information about your rights and potential next steps, and how to appeal a long-term disability denial.

What is Long-Term Disability?

A long-term disability claim arises when a person suffers a personal injury that affects their ability to work, function, and live in the long run. Traumatic brain injuries, spinal cord injuries, various injuries suffered during an accident, psychological injuries, and mental health issues are just some examples of injuries that can lead to long-term disability claims. These types of injuries can impact your life in a serious manner, sending you from financial independence to needing long-term disability benefits.

Long-term disability involves insurance benefits that generally begin when other benefits from your employer, such as short-term disability benefits, have ended. The purpose of long-term disability insurance is to offset your financial difficulties if you lose your source of income, and often, the goal of this claim is to provide you with funds for bills and expenses, medical treatments, and rehabilitation costs. 

What Are Some Common Reasons Disability Claims Get Denied?

There are several reasons an insurance company may deny your long-term disability claim. For example:

  • Your claim may not meet the insurance company’s definition of long-term disability. Before filing a long-term disability claim, you will want to review your insurance policy and make sure you understand the conditions that make you eligible and fulfill the definition of disability used by the insurance company. Look for any excluded conditions, as well as the company’s definition of what constitutes a disability.
  • There may be insufficient evidence to prove your claim. Whether it be missing medical records or a lack of detailed explanations by your doctor, if you don’t provide sufficient evidence to back up your claim, it is likely to result in a denial.
  • You may not be receiving regular medical treatment, which is typically considered to be necessary by an insurer in order to strengthen your case. Lack of proper medical testing, imaging, and treatment at regular intervals can work against you in your long-term disability claim.
  • There may be a procedural reason for the denial. For example, you may have missed a deadline or failed to communicate with the insurance company, causing them to reject your claim.
  • Upon investigation, the insurance company may have discovered that you were acting against your doctor’s restrictions. It is common for an insurer to perform investigations and even video surveillance of long-term disability claimants. If you are found to engage in an activity that is inconsistent with your allegations of disability, your claim may be denied and any previously awarded benefits may be terminated.

What Should You Do if Your Claim is Denied?

If your claim is denied, you will have the right to appeal the decision. You should know, however, that a long-term disability denial appeal is not a formal legal proceeding; rather, it is a process used by the same insurance company that denied your claim. During this process, you present your evidence to the insurer, and there is no neutral decision-maker involved. This means that generally, long-term disability appeals rarely succeed.

You also need to be aware of the deadline to start an action against your long-term disability benefits insurer.  You have 2-years from the date of your original denial to file a claim in court and not from the date of your last appeal.  I caution people to be aware of the timelines as the appeals process can be long and dragged out, which is why it may be best to skip it entirely.

If your appeal is unsuccessful, you can file a claim in court to enforce your legal right to long-term disability benefits. Because this process can be complex and involved, the help of an experienced long-term disability denial lawyer can be invaluable. They can put together a strong case on your behalf, based on the evidence, and present that case in court. They can investigate the unique facts of your claim and preserve important evidence. They can communicate and negotiate with the insurance company in order to obtain a favorable and fair settlement. 

How Can Derek Wilson Help Maximize Your Chances of a Successful Appeal?

Not only have I successfully represented many clients with long-term disability claims, but for over a decade prior to that, I worked for insurance companies, which helps me uniquely understand what insurance companies are looking for and what makes a long-term disability claim strong. I will focus on presenting your claim for long-term disability insurance benefits in a way that meets the requirements of your specific policy, demonstrating the full scope of your damages and unique situation.

My firm focuses only on personal injuries and represents clients with long-term disability claims. We provide fair and honest legal advice with a focus to help clients recover fair compensation with no up-front fees. Call us at 855-769-0418 or get in touch online to schedule a free consultation.

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