If you are an employee covered by a long-term disability insurance policy from USAble Life, you may need to file a claim after a serious illness or injury. Unfortunately, even legitimate LTD claims are sometimes denied. This guide offers key information to help you understand the process, avoid common mistakes, and know what to do if your claim is denied. If that happens, seeking the help of a USAble Life disability attorney could significantly improve your outcome.
Tips for Long-Term Disability Claims with USAble Life
At this early stage, your goal is to build a clear, credible case for why you can’t perform your job duties. USAble Life will be looking closely at the details, so the way you start your claim matters.
Here are a few tips that can help set the tone for a smoother process:
- Get the Ball Rolling Early: Let your HR department or benefits coordinator know you’ll be filing an LTD claim. They’ll provide the right forms and can often help you stay on track with deadlines.
- Treat Your Claim Forms like Legal Documents: Be honest and specific about how your condition affects your daily work tasks—not just how you feel, but what you physically or mentally can’t do.
- Ask Your Doctor to be Thorough: The Attending Physician Statement is one of the most important parts of your claim. Make sure your physician explains how your condition limits your ability to work, not just your diagnosis.
- Keep Detailed Records: Save copies of everything you submit, and consider keeping a journal of your symptoms, appointments, and communication with the insurance company.
This isn’t just paperwork—it’s the foundation of your claim. A careful, well-documented application won’t guarantee approval, but it gives you a stronger position if your claim is questioned or denied later.
Common Pitfalls That Can Lead to a Denial
Even minor errors or omissions can result in a long-term disability claim being denied. Some common issues include:
- Incomplete or Vague Medical Documentation: USAble Life may argue that your medical records do not fully support the claim.
- Delays in Submitting Forms: If documentation is submitted late, the insurer may deny the claim for “lack of timely proof.”
- Inconsistent Statements: If the limitations you report do not match your medical records or social media activity, this may raise red flags.
- Failure to Meet the Definition of Disability: This often depends on your job duties and how your condition affects your ability to perform them.
Being aware of these common pitfalls can help you to present a stronger initial claim and reduce the risk of denial.
What to Expect During the Review Process
Once your claim has been submitted, USAble Life will review your medical records, job description, and any other relevant documentation. They may:
- Request additional records or clarification from your doctors.
- Send you for an independent medical exam (IME) or functional capacity evaluation (FCE).
- Conduct surveillance or online investigations.
This review process can take several weeks. It is important to respond promptly to any requests and to continue with your regular medical treatment in order to document your condition.
How to Appeal a Denied LTD Claim
If USAble Life denies your claim, there is no need to panic as you have the right to appeal. This is your chance to clear up any misunderstandings, provide more evidence, and strengthen your case.
Steps to take:
- Review the Denial Letter Carefully: USAble Life must explain why your claim was denied and what evidence they relied on.
- Gather Supporting Documentation: This may include updated medical records, specialist opinions, or a detailed statement from your doctor.
- Submit a Timely Appeal: Most group LTD policies governed by ERISA give you 180 days to file an appeal.
- Consider Seeking Professional Help: A USAble Life disability attorney can help you to build a persuasive appeal package, particularly if the initial denial was based on weak or biased evidence.
Taking these actions can significantly improve your chances of overturning the denial and receiving the benefits you deserve.
Real-world example: A Baptist Health employee was denied benefits after USAble Life claimed her condition was ‘not severe enough’. However, her attorney submitted updated testing results and a vocational expert’s report explaining why she could not return to her role. Thanks to the additional evidence, her claim was approved on appeal.
When to Contact a USAble Life Disability Attorney
Long-term disability claims can be complex, and dealing with a denial can be overwhelming. However, you don’t have to navigate the process alone. If USAble Life has denied your LTD claim, contact us for a confidential case review.
Understanding the fine print, gathering the right evidence, and working with an experienced USAble Life disability attorney can make all the difference. Call (888) 321-8131 today to get help with your claim.
