Dealing with the Long Term Disability (LTD) claims process can be a difficult and emotional experience, particularly when your claim is denied. A denial of benefits doesn’t mean the end of your chances for recovery from your policy, whether it’s obtained through your employer or privately. If you are prepared to fight back and properly represented, you may be able to obtain the benefits that are rightfully yours.
We’ll go over some of the reasons for LTD claim denials, how an attorney can help make your case stronger, what you can do to help, and why you should seek out legal assistance.
Why Long Term Disability Claims Get Denied
Initial LTD benefits are often denied, due to any number of reasons, including administrative mistakes, medical evidence disputes, etc. Typical denials may be:
- Lack of medical documentation: Your medical records do not clearly document your ability or inability to work because of your condition. (fieldslaw.com)
- Disagreements over definition of a disability in the policy: The insurance company argues that your disability does not qualify under the stated conditions in your disability policy. (fieldslaw.com)
- Missed deadlines or incomplete paperwork: Filing mistakes can make a claim unreadable even before it reaches the claimant. (nolo.com)
- Surveillance or misinterpretation of your activity: Insurers sometimes use surveillance to argue you’re not as limited as your doctors say. (fieldslaw.com)
It is important to know the exact reasons for your denial – and this is where an experienced LTD lawyer can help.
The Importance of Acting After a Denial
Receiving a denial letter can be daunting, but most disability plans have time limits for appeal, and you have the right to appeal. For example, group employer‑sponsored plans governed by the Employee Retirement Income Security Act (ERISA) generally give you at least 180 days from the denial notice to file your appeal. (dol.gov)
If you miss this window, your case may be lost forever even if your disability is clearly shown, and you are eligible.
How can lawyers help you win your LTD claim?
1. Analyze Your Denial Letter and Policy:
Your denial letter will provide an explanation as to why the insurer denied the application. An experienced LTD lawyer will:
- Analyze the language of the policy.
- Point out any missing pieces in the evidence submitted.
- Identify administrative and legal mistakes by the insurance company.
This is the first step as it sets the foundation of your appeal.
2. Collect and Compile Medical Records
LTD claims are frequently won or lost based on medical records. Lawyers help by:
- Asking for new health records from your health care provider(s).
- Presenting information in a way that demonstrates the severity and restrictions.
- Collaborating with the Doctor to draft medical statements consistent with the definition of disability in the policy.
If you have a well-documented case, it is much more likely you will be approved.
3. Write a Strategic Appeal
An appeal isn’t just a piece of paper, it’s a legal document. Attorneys make sure that your appeal is handled correctly:
- Finds answers to all denial reasons.
- Refers to relevant medical and scientific evidence.
- Makes convincing arguments linking disability to policy language.
This amount of detail can be the difference between approval and another denial.
4. Go Through the Administrative Appeal Process
To prevail in a legal action in court (particularly under ERISA), internal appeal levels must be exhausted first. Attorneys can advise claimants on the following:
- First-level appeal
- Second level appeal (if applicable)
- Higher administration reviews (getmyltdbenefits.com) are available as an option.
Professional advice guarantees that deadlines are respected and procedural requirements that conform.
5. Get Ready For Litigation (If Applicable)
If the appeal is rejected, then the next step is federal court. This is what an experienced lawyer is ready to:
- Filing a lawsuit on your behalf.
- Present a case to a judge in a way that is convincing.
- Present a complete administrative record. (hg.org)
In ERISA cases, the administrative appeal process may be the only opportunity to present evidence, making it imperative that the cases are well represented. (legalclarity.org)
Actionable Steps After Your LTD Claim Is Denied
- Thoroughly review your denial letter — look for any appeal deadlines.
- Immediately talk to the disability lawyer.
- Ask the insurance company for a complete claim history.
- Collect new medical statements and medical records.
- Prepare your appeal with legal guidance.
Prompt action will help to safeguard your rights and enable you to receive benefits.
FAQs
Q1: How long do I have to appeal a denied LTD claim?
With ERISA, most plans provide 180 days from the date of the denial notice to appeal. For exact deadlines, see your denial letter, as this can differ.
Q2: What if my appeal is also denied?
After an internal appeal (especially where ERISA is applicable), you can sue in federal court. This needs an attorney’s help and must be done in time limits as prescribed by law.
Q3. Can new evidence be submitted after appeal?
In most LTD cases (particularly ERISA cases), the administrative appeal is all you get to present evidence; courts usually won’t hear new evidence thereafter.
Q4: Should I hire a lawyer to appeal my LTD denial?
Though not necessary, it does greatly improve your odds of success and reduce mistakes of process by having an experienced lawyer present.
Q5: How many days can take in the appeal process?
You usually have months to put together your appeal and the insurance company has a specific amount of time to review it (this usually takes 45-60 days and can be extended) before making a determination.
Conclusion
The denial of Long Term Disability benefits can be a huge blow, but it’s far from the end. With the help of a professional lawyer, you can create a compelling argument, maneuver the appeal process successfully and improve the odds of obtaining the benefits you deserve.
It’s important to act quickly, and with a strategy in mind, knowing what lawyers can do will ensure that your claim is supported throughout the process.
