Long-Term Disability Lawyers in Arizona

Helping Clients Receive Disability Benefits

If you have sustained a health-related issue that leaves you unable to work, you deserve to receive benefits under a long-term disability (LTD) program. These programs are made to protect workers from losing income due to an injury, illness, or accident. Unfortunately, proving that you need long-term disability can be a long and arduous process, and many individuals find they are unfairly denied after making legitimate claims. Being denied payment from a long-term disability insurance program can be devastating, leaving you and your family members unable to support yourselves after you are unable to work.

Our team at Roeschke Law is here to assist you with any long-term disability insurance claim you may be pursuing. Whether you are on short-term disability and think you may need long-term payments or you’ve already made a claim and been denied, our attorneys can help. With our years of experience in the disability industry, we can use our knowledge to support your claim and get you the benefits you deserve. For more information about our services and how we can help you, contact our law office today by calling 480-999-4740.

What is Long-Term Disability Insurance?

Long-term disability income insurance is made to support employees in the event of an injury or illness that prevents them from working long-term. If you cannot work for an extended period of time and have long-term disability insurance, your insurance company will theoretically pay you every month up until the day you can return to work or retire.

If you suffer an illness or injury, you must first apply for short-term disability support. Your insurance company will assess your inability to work and any relevant evidence to support that claim. The company will then decide whether you are eligible for coverage or not and inform you of that decision. You’ll then either be awarded payment or you can appeal if you are denied.

Short-term disability coverage lasts for a short while, typically anywhere from three months to one year. If you are still unable to work after the short-term disability insurance period is over, you must then reapply for long-term disability. The insurance company will again assess your inability to work and your eligibility for compensation. Unfortunately, insurance companies are often hesitant to award long-term disability payments, which can lead to unfair denials of legitimate claims. If long-term disability is awarded, it can last up to retirement age, which can be expensive for the insurance company.

What is the Long-Term Disability Claims Process?

Before applying for long-term disability, it’s essential to read and understand your insurance policy fully. You must be aware of any stipulations or limitations related to your coverage before applying. Otherwise, your application could be denied automatically, leaving you without a way to provide for your family.

Once you understand your insurance policy, the next step is to talk to your doctor who is providing treatment for your condition. While primary care and family doctors are technically acceptable, specialists are much better at providing specific information related to your illness or injury. Without support from a doctor, it is unlikely that your claim will be approved. You must also understand what is in your medical records and how you can support your claim. Any ambiguous dates of disability or pre-existing conditions can affect your coverage and your payments. It is recommended to talk to a member of our team before filing for a better chance of success.

Once you are ready to apply for benefits, you must submit documents and evidence to show proof of your medical condition that limits your ability to work. Secondary mental conditions, like anxiety or depression, are typically not relevant to LTD benefits and do not need to be noted in your claim. Always answer insurance questions honestly and to the best of your ability, and avoid using statements that can be easily disproven. Try not to use words like “always” or “never,” and instead use words like “seldom” or “frequently” when describing your ailments.

If your insurance company asks you a yes or no question, do not feel pressured into answering it with a yes or a no. Many disabilities are not cut and dry, and you can attach a second sheet with an explanation to your form if needed. The more detailed information you include about your disability, the more likely it is that you will receive LTD benefits.

Always include your medical records and documentation of your functional deficits when submitting a claim. Your insurance company may ask the healthcare professionals treating you to answer questions about your condition. You can ask your doctor or other healthcare providers to provide information about your condition to your insurance agent if they ask. Many policies require your doctor to fill out forms about your condition as well.

After filing your Arizona LTD benefits claim, your insurance company will likely ask you for additional information. This can include phone interviews and appointments with doctors. Your insurance company may also have a third party review your medical information and your records to give their expert medical opinion. There will likely be a waiting period of a few weeks or months before you hear a decision.

It is essential to provide information that supports your claim for long-term disability benefits. If you need help at any point during the claims process, our team of attorneys is here to assist you.

Why Are Long-Term Disability Claims Denied?

Unfortunately, you could go through the entire application process only to receive a denial notice. While there are many reasons for an LTD denial, there are some reasons our team sees often.

Those reasons include:

Errors on the Application

Even minor issues can be interpreted as a failure to disclose medical information. If your application is not accurate or is missing information, your claim may be denied.

Not a Qualifying Disability

LTD insurance policies often have their own definitions of disability. If you do not prove that you have a disability according to the company’s definition, they will deny your claim.

Missed Deadlines

ERISA has stringent deadlines for submission. If you miss a deadline, your insurance company may use it as an excuse to deny your claim.

Insufficient Evidence

Insurance companies rely on your medical records to make their decision. If your medical records are incomplete or not backed up by medical professionals, your insurance company may deny your claim.

Surveillance Tactics

Because LTD benefits cost insurance companies a lot of money, they will sometimes hire private investigators to perform surveillance on individuals who file claims. If a private investigator finds that you are able to perform routine or even semi-normal work duties, they will use this to deny your claim.

Independent Medical Exams

Some insurance companies will require you to receive a medical exam from their own doctors. Unfortunately, these doctors can be biased, and insurance agents may use these doctors’ opinions to deny your claim.

Can You Appeal a Denied Long-Term Disability Claim?

It’s an unfortunate fact that insurance companies deny more than half of long-term disability claims. The good news is that you can appeal the decision if you disagree with it. The appeals process depends on the law that governs your insurance policy. If your claim is governed under the federal Employee Retirement Income Security Act (ERISA), then you have 180 days from the initial denial to submit an appeal. If your claim is governed by the state, you may have a different timeline.

Always keep the denial letter with the envelope it came in to prove the date that it was mailed and received. Review the letter carefully to fully understand why your claim was denied and any other relevant information. Some claims are denied due to medical reasons, while others are simply technical issues, like missing forms or information. The denial letter will also explain how and when to make your appeal, so be sure to read it thoroughly.

Once you are ready to submit your appeal, be sure to gather any information that was missing from your initial application. Your denial letter should tell you what you are missing, but it’s up to you to find it. You may have to contact your healthcare provider and request documents or forms. Similarly, additional evidence and medical tests may stack the evidence in your favor. Blood tests, MRIs, CT scans, and X-rays can all be proof of your medical condition. Generally, the more evidence you include, the higher the chance of success you have.

You can also request written letters from your doctors or opinions from friends and family about your condition. People who know you well can write about your daily struggles and limitations, while vocational experts can provide their opinions about your disability and how it impacts your ability to work. Healthcare providers will often include their opinions in your records to use in your submission.

If you are concerned about the appeals process or unsure where to start, our team can help. With an experienced disability attorney on your side, you can rest assured knowing that you are gathering all the necessary information to submit your appeal. We understand the situation can be overwhelming, and we are here to provide assistance if you need it.

What is Long-Term Disability Litigation?

If you make an appeal and it is denied, you can then move on to long-term disability litigation. Litigation can only be started after an official appeal is made, so it’s best to make an appeal if you haven’t done so already. Similarly, the only evidence that will be considered in an LTD lawsuit is what you have submitted in your initial application process and the appeals process.

If ERISA governs your long-term disability plan, you have the right to take legal action against your employer or your insurance company if your claim is denied. This litigation typically happens in federal court because federal law governs what happens with employee benefit plans. Typically, there is no jury during ERISA litigation, and a judge makes all decisions about the lawsuit. The hearing usually consists of any paper records you have, along with cross-motions. The judge will issue their final decision after hearing from you and your legal representation, as well as the other party.

In some cases, the court will defer to the insurance company’s decision instead of making their own. For instance, the court may find that the insurance company had a reasonable basis for denying the claim. This can be a very difficult argument to counter against, so it is essential to reach out to our team if you wish to pursue legal action.

How Can a Long-Term Disability Lawyer Help Me?

Being unable to work because of an illness or injury can be a very stressful experience. Long-term disability income insurance was created to provide payment to workers who are unable to perform their job duties. Unfortunately, insurance companies and employers are often hesitant to approve these claims due to their high costs. If you are making a claim or have already had a claim denied, you have the right to seek legal counsel.

Our team at Roeschke Law has years of experience helping clients get their deserved payments. From filling out the initial application to making an appeal to filing a lawsuit, we can guide you through the LTD benefits process. Please don’t feel like you must go through this complex process on your own. Call our office today at 480-999-4740 to speak with a compassionate and experienced attorney on our team.