Types of Long-Term Disabilities: Chronic Illnesses

What is Long-Term Disability Coverage?

Long-term disability coverage (LTD) is a type of insurance that provides financial benefits to workers who are unable to work for long periods of time. Typically, this is due to an accident, injury, or illness. Regardless of whether or not your injury took place in the workplace, long-term disability coverage will provide you with a percentage of your income until the day you are able to return to work or retire. To take advantage of long-term disability coverage, you must file a claim with your insurance company, proving that you have an illness or injury that makes it impossible to perform routine work functions.

Unfortunately, insurance companies are often hesitant to approve long-term disability claims because of the high costs associated with them. Over half of all long-term disability claims are denied for various reasons, including application errors, lack of medical evidence, and lack of a qualifying disability. The Social Security Administration (SSA) has a list of qualifying disabilities they use to approve or deny claims. If your illness or injury is not on that list, it doesn’t mean your claim will get rejected, but there is a higher likelihood that it will not be covered.

For workers who can no longer perform their work functions, long-term disability coverage can be life-changing. Being unable to work and provide for your family is disheartening as well as frightening, especially if your insurance company is unwilling to provide the benefits that you deserve. Fortunately, working with an experienced team of disability attorneys improves your chances of getting approved for long-term disability coverage. If you have questions about your long-term disability benefits or would like assistance filling a claim, contact our office today by calling 480-999-4740.

Which Chronic Illnesses Qualify for Long-Term Disability Benefits?

The Social Security Administration has a list of chronic illnesses that qualify for long-term disability benefits. While having one of these illnesses doesn’t automatically mean your claim will be approved, it increases your chances dramatically. Keep in mind that you must submit medical evidence, like medical records and statements from doctors, to prove that you have one or more of these illnesses.

Chronic illnesses, also called chronic conditions, are defined as medical conditions that persist for an extended period of time. Typically, chronic conditions do not have a “cure” and instead are treated by managing the symptoms of the illness. Most of these conditions require ongoing medical care over many years.

Some chronic illnesses that can qualify for long-term disability benefits include:

• Asthma
• Fibromyalgia
• Chronic lung disease
• Heart disease
• Kidney disease
• Liver disease
• Wilson’s disease

Other chronic conditions may also be covered under long-term disability benefits, even if the Social Security Administration does not list it. If you have a chronic condition that is not listed, your insurance company will compare it to the list provided by the SSA. If the condition is comparable to the ones on their list, you may be eligible for coverage. For more information about chronic conditions and whether or not you qualify, contact our law office today.

How Do You Get a Long-Term Disability Claim Approved?

Getting a long-term disability claim approved can be a long process, but it’s much easier with a team of long-term disability attorneys on your side. Before starting the application process, be sure to read your LTD policy thoroughly. Some insurance companies may have different definitions and policies that can affect how your coverage is approved.

Next, talk to the doctor or healthcare team in charge of treating your condition. Primary care doctors are fine, but meeting with a specialist is better. Specialists are considered experts in their fields, and their recommendations will carry more weight in your application. Talk to your doctor about your plans to submit an LTD claim so they can fill out forms or talk to insurance agents as needed. Your insurance company may reach out to your healthcare team with questions, so it’s essential to prepare them ahead of time.

Gather all the documents you need to submit your claim, including your medical records, statements from doctors, and work history. You must submit evidence of when you became disabled and the date that you stopped working. If you have secondary health conditions that stem from your chronic illness, like depression or anxiety, they do not need to be noted in your application, even if they impact your ability to work.

Depending on your insurance company, you may be asked to fill out a questionnaire with answers about your disability and how it affects your day-to-day life. Always answer these questions to the best of your ability, including details about your impairments and daily struggles. Never lie or exaggerate about your condition, as many insurance companies will use surveillance techniques to confirm your ailment is as impairing as you claim it is.

When you submit your claim, include any relevant medical records and your work history to prove that you have been unable to work due to illness or injury. Be prepared for your insurance company to reach out to your medical team for confirmation or further questions. Your insurance company may also contact you for additional information, like medical records or questions about your work history. You can seek legal counsel during any step of the application process, even if you just have a few questions.

Your insurance company will likely use its own third-party medical experts to review your claim. You may be contacted and asked to complete an independent medical exam for further review. Once your insurance company makes a decision about your claim, they will contact you, typically via certified mail. If your claim is accepted, you will start receiving monthly benefit payments. If your claim is denied, your denial letter will go into detail about submitting an appeal.

Why Would an LTD Claim be Denied?

It is an unfortunate fact that over half of long-term disability claims are denied the first time they are submitted. Insurance companies will use many factors to deny a claim, mainly because long-term benefits cost the company significant amounts of money. Some insurance agencies will even act in bad faith, meaning finding an illegitimate reason to deny a claim. If you believe your insurance company has acted in bad faith, it is crucial that you reach out to our team immediately.

Below are some of the most common reasons why a long-term disability benefits claim would be denied:

Errors in the Application

All long-term disability applications must be accurate and complete. If there is false or missing information in your application, your insurance company will likely deny your claim. If you choose to appeal, you can include missing information or correct false information.

Lack of a Qualifying Disability

Your insurance company has a definition of disability that they use to decide whether to accept or deny LTD claims. If your disability does not meet their definition, your claim will likely be denied. It is essential to read your insurance company’s policy to understand what their definition of disability is before applying.

Missed Deadlines

The government bodies that govern disability insurance claims have strict deadlines you must abide by. If you miss a deadline for any portion of the application, your insurance company will likely deny your claim automatically.

Lack of Medical Evidence

When submitting a claim for long-term disability insurance, you are required to include medical evidence proving that you have a disability. If your medical records do not include a diagnosis or your insurance company feels that your records do not prove you have a disability, they may deny your claim.

Independent Medical Exam

Some insurance companies use independent medical exams (IMEs) to prove or disprove your medical diagnosis. If a third-party doctor gives you an exam and disagrees with your medical team’s diagnosis or treatment plan, your insurance company may deny your claim. Unfortunately, these third-party doctors are often hired to side with insurance companies, making it difficult to disprove their diagnoses.

Surveillance Evidence

In some cases, insurance companies will hire private investigators (PIs) to surveil individuals who submit long-term disability benefits claims. If a PI finds evidence that you can perform typical work duties, like sitting, standing, walking, or running, your insurance company can use this evidence to deny your claim.

If your insurance company denies your initial application, your denial letter will go into detail about exactly why your claim was denied. Your letter will also explain how you can submit an appeal for another chance at receiving disability benefits. If you have questions about a claim denial or would like to submit an appeal with legal counsel, call our office today.

How Do You Appeal an LTD Claim Denial?

If your long-term disability claim is denied, it can be a disheartening experience. Fortunately, the denial letter you receive will explain exactly how to appeal your denial through your insurance company. You can gather additional evidence, like medical records, doctor’s statements, and work history information, to submit along with your appeal. Your insurance company will review your initial application plus any additional information to make a decision once again.

Additional tests, like X-rays, MRIs, and CT scans, can be helpful when submitting an appeal. If you believe that further tests would change your insurance company’s decision, talk to your doctor about getting them done before your appeal. You can also submit written testimonies from family members and loved ones about your disability and how it impacts your daily life. Ask your loved ones to recount specific instances where you could not perform typical activities, like walking, sitting, or standing for long periods of time.

In most cases, you have 180 days to submit your appeal after you receive a denial letter. Many insurance companies are governed by The Employee Retirement Income Security Act (ERISA), which has stringent deadlines for appeals. If your insurance policy is governed by the state, your timeline may vary. Contact our office today for more information about submitting an appeal.

If your appeal is denied, you can then work with our legal team to file a lawsuit against your employer or your insurance company. A judge will review your initial application as well as your appeal to determine if your claim was denied in good faith. Your insurance company can also submit evidence to show their process and why they denied your claim. The judge can either make a new determination or defer to your insurance company’s decision to deny your claim. To learn more about long-term disability litigation and how it can impact your case, call our lawyers today.

Can a Disability Attorney Help Me?

Chronic illnesses can severely impact your ability to work and support yourself and your family members. Long-term disability benefits are made to support workers who can no longer work to provide for themselves. Unfortunately, getting approved for these benefits can be difficult, as insurance companies are hesitant to spend so much money on an individual person.

Consulting with an experienced legal team can increase your chances of getting your disability benefits approved after your initial application. At Roeschke Law, our team of attorneys has years of experience dealing with insurance companies and long-term disability claims. We can help you gather the necessary evidence you need to prove that your disability impacts your daily life. If your claim is denied, we can help you submit an appeal and even go to court if necessary. Receiving long-term disability benefits can be life-saving, and you deserve to have your necessities paid for if you have an illness or severe injury. Please don’t feel like you must go through this process alone. Contact our office today by calling 480-999-4740.