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Helping You Resolve LTD Issues and Denials
If you suffer an injury, illness, or accident that leaves you unable to perform your essential work duties, you may be eligible for long-term disability benefits. Long-term disability (LTD) provides income to workers who cannot work and support themselves or their family members anymore. Depending on the nature of your illness or injury, you can receive monthly LTD payments until the day you return to work or retire. LTD benefits are provided by insurance companies and can vary depending on your insurance policy.
Applying for long-term disability benefits is a lengthy process and can take a lot of preparation beforehand. Many insurance companies are hesitant to award LTD benefits because of the high costs associated with them. Being denied payment from an LTD claim can be devastating, leaving individuals unable to support themselves and their family members as they deal with symptoms from an illness or injury.
Fortunately, by working with a team of experienced disability lawyers, you can increase your chances of getting your LTD benefits claim approved. Our team at Roeschke Law can help you file a claim with all the necessary information to improve your chances of getting accepted right away. If your claim is denied, we can guide you through the appeals process, offering legal resources at every step of the way. Please don’t feel like you must navigate the world of disability benefits on your own. Contact our office today by calling 480-999-4740 for more information.
How Does Long-Term Disability Work?
Long-term disability benefits provide payments to workers who are unable to work due to illness or injury. These payments are provided by insurance companies and are typically offered by employers. If you suffer an illness or injury, you can file a long-term disability claim to begin receiving monthly benefit payments. These payments last until you can return to work or retire.
Before you apply for New Mexico LTD benefits, you must apply for short-term disability benefits first. Short-term disability benefits provide monthly payments to workers who cannot fulfill their duties for a short period of time, typically between a few months to one year. You must submit a claim to your insurance provider, who will decide if you qualify for short-term disability. If so, you will be awarded monthly payments.
Once your short-term disability benefits period runs out, you can submit a claim for LTD benefits. Your insurance company will again assess your needs and your ability to work and support yourself. LTD benefits claims are scrutinized more closely, as they cost insurance companies much more money. It’s an unfortunate fact that insurance companies sometimes deny legitimate claims to save money. You can work with our team of long-term disability lawyers to file a claim for a better chance of success.
What is the LTD Claims Process?
Before starting the application process for long-term disability insurance, sit down and read your LTD policy carefully. Different insurance policies have different rules and regulations, and yours may require more or less information from you when submitting a claim.
Next, talk to your doctor and advise them of your plans to submit an LTD claim. Your insurance company will likely want to interview your doctor or at least get a written statement from them, so it’s best to alert them ahead of time. Try to seek medical treatment from a specialist who is treating your condition rather than a primary care doctor. Specialists have expert knowledge in their field, which can help sway your insurance company’s decision.
Gather all documents required to submit an LTD claim, including your medical records and work history. Secondary conditions, like mental health issues, typically do not need to be noted in your claim, even if they hinder your ability to work. Your insurance company will likely ask you to record the exact date you became disabled and when you stopped working.
Your insurance company will likely ask you to fill out a questionnaire detailing information about your disability. Always answer these questions honestly and to the best of your ability, elaborating in detail when necessary. Try to avoid using words like “never” or “always,” and instead try phrases like “sometimes” or “frequently” so they cannot be easily disproven. If there is a yes or no question that you feel requires further explanation, attach a second sheet with details explaining your disability and how it relates to your work performance. In general, the more details you include in this questionnaire, the higher chance you have of success.
When submitting your claim, include your medical records and work history records showing the last time you were able to perform your job duties. Your insurance company may reach out to your doctor or healthcare provider for more information if needed. Some policies may also require your healthcare team to fill out a survey about your diagnosis and prognosis. Your insurance agency may also reach out to you with further questions or requests for more documentation and information.
Insurance companies have been known to use third-party medical experts to review LTD benefits claims. Your insurance company may hire a medical doctor or healthcare professional to review the facts of your claim. Once your insurance company has decided whether to accept or reject your claim, they will contact you, typically via the mail. If you are rejected, the letter will instruct you on how to submit an appeal.
Why Was My Long-Term Disability Claim Denied?
Insurance companies are often hesitant to approve LTD claims due to the high costs associated with them. While the denial letter you receive will go into more detail, there are a few reasons why your claim may have been denied.
The most common reasons for an LTD claim to be denied include the following:
Missed Deadline
The federal government has strict deadlines for submitting disability benefits claims. If you miss one of these deadlines, even by a day, your insurance company may deny your claim without looking at your application.
Errors
Incomplete or incorrect information on your application can lead to an automatic denial. Even seemingly innocent mistakes can cause your claim to be denied.
Not a Qualifying Disability
Your insurance company likely has its own definition of what a disability is. If your medical records do not show that you meet their definition of disability, it is unlikely that your claim will be approved.
Independent Medical Exams
Independent medical exams (IME) are done by doctors hired by your insurance company. If your insurance company doesn’t agree with your doctor’s diagnosis, they may require you to get an IME. Unfortunately, these exams are often used to disprove your diagnosis and deny your claim.
Surveillance
Some insurance companies hire investigators to do surveillance on individuals who submit disability benefits claims. If a private investigator can show proof that you are performing normal work activities, this evidence may be used to deny your claim.
How Do You Appeal an LTD Denial?
Receiving a denial notice can be frustrating, but fortunately, you have recourse. There is an official appeals process you can go through to appeal your denial and prove you require disability benefits. The process varies slightly depending on your insurance policy. If your policy is governed by The Employee Retirement Income Security Act (ERISA), then you have 180 days to submit an appeal. If your policy is governed by the state, your timeline may vary. Contact us for more information if you aren’t sure how to appeal an LTD denial.
To submit an appeal, first read your denial letter carefully to understand why you were denied. Your letter should go into detail about why your claim was not considered valid. If it is something as simple as an error or missing information, you can easily correct that when submitting your appeal. If there is a more significant issue, like a lack of medical evidence, it could require more work on your end.
Gather any information missing from your initial application, including medical records and work history documents. You can also include additional evidence, like statements from doctors or healthcare workers if you believe it would change the decision. Other tests like blood tests, X-rays, MRIs, and CT scans may also bolster your claim and help you get your benefits approved. Generally, the more evidence you provide of your disability, the higher the chance of success you have.
You can also get written statements from friends and family members about your disability and how it limits your capacity to work. If your claim was denied for insufficient evidence, this is a valuable tactic to improve your claim. Ask your friends, family members, and colleagues to include information about your daily struggles and your inability to perform routine work functions.
After you have any additional evidence you would like to include, follow your insurance company’s instructions on submitting an appeal. Our team can help you gather the necessary information and submit an appeal through your insurance company for a higher chance of success. We understand how disheartening it can be to receive a denial notice, and we are confident we can help you through the appeals process. For more information, contact our attorneys today.
Can You Sue for an LTD Denial?
If your appeal is denied, you can look into long-term disability litigation. Litigation involves filing a civil lawsuit against your insurance company or your employer for denying your benefits. You can demand back payments and future payments if you believe your claim was unfairly denied or denied in bad faith. It is important to note that you can only pursue LTD litigation if you have gone through the official appeals process first. The only evidence that can be presented during LTD litigation is what you submitted during your initial application and during the appeals process.
All insurance policyholders governed under ERISA have the right to file a lawsuit in federal court. Most LTD hearings do not involve a jury, and all decisions are made by a federal judge. The judge will examine all evidence you have provided, including your initial application and your appeal, before making their decision. They will also hear from the other party to determine why your claim was denied and whether that process was completed correctly.
The court may decide to approve your claim and demand the insurance company pay you disability benefits. The court can also choose to defer to the insurance company’s opinion and deny your claim again. It is essential to have an experienced team on your side who can present the evidence in your favor to prove that your claim is legitimate. If you are interested in LTD litigation, our attorneys can help you.
What Does a Long-Term Disability Lawyer Do?
Long-term disability benefits were created to assist workers in need who can no longer perform their necessary job duties. Unfortunately, insurance companies are often hesitant to accept these claims because of the high costs associated with them. Insurance agents may act in bad faith to attempt to deny your claim unfairly, leaving you and your family members without a way to support yourselves.
As your long-term disability lawyers, our team at Roeschke Law can help you gather your medical evidence and work history for a higher chance of approval. If you have already submitted your claim and are facing a denial, we can guide you through the appeals process as you introduce new evidence. If you have already appealed, we can start the LTD litigation process to fight for your income. Contact our office today by calling 480-999-4740.