Long-Term Disabilities: Physical Disabilities

What is Long-Term Disability Insurance?

Long-term disability insurance (LTD) is a type of insurance made to protect employees. More specifically, this insurance provides monthly payments to individuals who develop illnesses, injuries, or other ailments that prevent them from working. Long-term disability gives workers a percentage of their income so they can continue to support themselves and their families even while they cannot work. To take advantage of long-term disability insurance, individuals must prove they cannot perform normal work functions and are unable to support themselves financially through any other means.

Long-term disability insurance is provided by insurance companies that are governed by the state or federal government. To qualify for long-term disability insurance coverage, you must prove that you have a qualifying disability. Many disabilities qualify for long-term disability insurance, including physical disabilities. Understanding which disabilities are covered by your insurance company will help you when filing your claim.

Unfortunately, insurance companies will sometimes attempt to deny a claim unfairly to increase their own profits. Insurance companies must spend a lot of money when a long-term disability claim is accepted since an individual can receive payments up until they go back to work or retire. Because of this, over half of long-term disability claims are denied, leaving many workers without a way to support themselves or their families.

With the help of an experienced legal team, you can submit your claim correctly and with enough medical evidence to convince your insurance company that you need long-term disability payments. Many individuals find a higher chance of success when working with a team of attorneys, whether it’s submitting an initial application, making an appeal, or taking their insurance company to court. If you’d like a higher chance of receiving disability insurance payments, don’t hesitate to reach out. Call our office today at 480-999-4740.

Which Physical Disabilities Are Covered by Long-Term Disability Insurance?

A physical disability is any condition that limits the physical function of one or more limbs. Physical disabilities can be temporary or permanent and are often caused by accident, injury, or illness. There are many types of physical disabilities, and not all of them are covered by every insurance policy. It is essential to read your insurance policy all the way through to determine if your physical disability is covered.

Generally, physical disabilities covered by long-term disability insurance include the following:

• Cerebral palsy, including spastic cerebral palsy, spastic diplegia, spastic hemiplegia, and spastic quadriplegia. Cerebral palsy impacts a person’s ability to move and maintain their balance. It is typically present at birth.
• Spinal cord injuries. Spinal cord injuries include any damage to the nerves at the end of the spinal cord or the spinal cord itself. These injuries can result in loss of strength, sensation, mobility, and feeling.
• Amputation. Amputation is the removal of part or all of a body part enclosed by skin. Accidents, surgery, or animal attacks cause most amputations.
• Spina bifida, including spina bifida occulta and myelomeningocele. Spina bifida is a congenital disability when the spine and spinal cord do not form properly. Symptoms can be minor or severe.
• Musculoskeletal injuries. Any damage to the muscular or skeletal system is referred to as musculoskeletal injuries. They are typically caused by work-related activities or other strenuous activities.
• If your physical disability is not listed in your insurance policy, you can still file a long-term disability claim. Your insurance agency will likely compare your disability to the ones on their list to determine if it is comparable in symptoms or severity. Your insurance company may also rely on third-party medical experts to review your claim and decide whether or not you qualify for long-term disability payments.

What is the Long-Term Disability Claims Process?

When preparing to submit a long-term disability claim, first read your insurance policy carefully. Some policies require different information, and it’s essential to understand what you’ll need to submit ahead of time. If you do not have a copy of your long-term disability insurance policy, contact your employer or your insurance company directly.

Next, gather all of your medical evidence, including your medical records and statements from your healthcare team. Your medical records must show your disability diagnosis as well as your treatment plan and any future treatments you are planning to get. Tests like X-rays, MRIs, CT scans, and blood tests are very valuable when showing evidence of a disability.

Talk to your doctor to inform them of the fact that you are submitting a long-term disability claim. There is a chance your insurance company will contact your healthcare team and ask them questions, so it’s best they know ahead of time. Make sure they support your decision to seek long-term disability payments to ensure they will advocate for you and your medical condition.

Your insurance company will most likely have you submit a questionnaire about your disability and your symptoms. Answer any questions to the best of your ability, including as many details as you can recall. If there are any yes or no questions, feel free to elaborate on your answers instead of using a single word. Try not to use statements that can be easily misinterpreted or disproven, as your insurance company will be going through this questionnaire very thoroughly. If you have questions about filling out this form, our team of attorneys can help.

When you submit your claim, include your medical records and your work history records showing when your last date of employment was. Your insurance company will want to know the day you became disabled and the day of your last job. If any of these dates are inaccurate or not disclosed, your insurance company may deny your claim.

If your insurance company has questions or would like more information, they may reach out to you for clarification. They may also contact your doctor or healthcare provider for additional documents, like test results and treatment plans. After a few weeks or months, your insurance company will contact you with their decision about your claim. If it is approved, you will receive monthly payments. If your claim is not approved, you can try again by going through the official appeals process.

Why Was My LTD Claim Denied?

Due to how expensive long-term disability payments are for insurance companies, the unfortunate fact is that many people face a denial from their initial application. If you receive a denial letter, it should explain exactly why you were denied and what your next steps are. However, there are some common reasons why an LTD claim would be denied that our team often sees.

Your long-term disability benefits claim may have been denied because of the following reasons:

Lack of Medical Evidence

Medical evidence includes medical records and statements from your healthcare team about your physical disability. If your insurance company feels that you did not include a significant amount of medical evidence, your claim may be denied. This could be because your diagnosis was not clearly recorded or because your treatment plan was not developed enough.

Independent Medical Exams (IME)

Independent medical exams are done by doctors who work for insurance companies. These doctors perform their own medical exams to either corroborate or disprove what is in your medical record. If your IME shows that you do not have a severe enough physical disability to qualify, your insurance company can use this to deny your claim.

Errors

When submitting your application, it is pertinent to ensure there are no errors or omissions in any documents. Even the smallest of mistakes, like an incorrect date, can cause your claim to be denied. It is recommended to have a member of our legal team review your claim before you submit it to avoid any errors.

Lack of a Qualifying Disability

If your disability is not listed in your insurance policy, it’s possible that your insurance company does not count your particular disability as a qualifying one. Insurance companies may use this information to deny your claim.

Missed Deadlines

Insurance policies that are governed by the state or federal government have strict deadlines you must adhere to. If you miss a deadline for your claim submission, your insurance company will likely deny it automatically.

Surveillance

Some insurance companies, especially larger ones with more resources, will hire private investigators to collect evidence on individuals who file claims. If a private investigator finds evidence that you can perform typical work duties in spite of your disability, your insurance company can use this evidence against you.

Can You Appeal an LTD Claim?

While getting a denial letter can be frustrating, the good news is that you have options. If your LTD benefits claim is denied, you can submit an appeal through your insurance company to request that they reconsider your claim. You can also submit additional evidence proving that your claim is legitimate and that you deserve disability payments.

To submit a claim, first read your denial letter carefully. The letter will explain why you were not approved and what evidence was missing from your claim. If you were missing any documentation, like medical records, work history, or statements from doctors, spend some time gathering that information before submitting your appeal. If there are any additional tests you would like to receive before your appeal, talk to your doctor about doing those. You have 180 days from the date of your denial letter to submit your appeal.

You can also request written statements from friends and family members about your disability and how it impacts your ability to work. Ask your friends and family to write statements about how difficult it is for you to do daily tasks, like standing, sitting, or walking for long periods of time. If you have not already, you can also ask your doctor or medical team to provide statements on your behalf as well.

Once your insurance company receives your appeal, they will review your initial application as well as any further evidence in the appeals process. Your insurance company may approve your request, or they could deny your claim again. In that case, you can pursue legal action against your employer or your insurance company.

If you would like to pursue long-term disability litigation in court, our team can help. We will review your case and determine whether your claim was unfairly dismissed. We can also help you file a lawsuit and present your evidence before a judge. In court, the only evidence that can be presented is what is in your initial application, plus any additional evidence you submit during your appeal. The judge can choose to approve your claim, or they can defer to the insurance company’s original denial notice. For more information about LTD litigation, contact our office today.

What Can a Long-Term Disability Attorney Do for Me?

Long-term disability insurance payments are essential in supporting you and your family if you can no longer work. Unfortunately, these payments can be difficult to qualify for, as insurance companies are very hesitant to approve anyone’s claims. You have a much higher chance of success when working with an experienced team of disability benefits attorneys who can guide you through the claims process, up to and including long-term disability litigation.

At Roeschke Law, our lawyers have years of experience helping clients get their claims approved to receive the benefits they deserve. Whether you’re starting an application from scratch or would like to escalate your appeal, we can assist you. We know the ins and outs of the disability claims process, and we can help you gather medical evidence to prove that you have a disability that hinders your ability to work. For more information about our services and to talk to a member of our team, call our office today at 480-999-4740.