Long term disability insurance companies want to get an unbiased opinion and concrete proof that you cannot work before they will approve your LTD claim. The documentation that you submit will be referred to as your “administrative file.” Everything that is relevant to your case must be in your administrative file, including all the documentation that you want to present as proof of disability.
In addition to medical and lab reports, insurance companies want to know the following:
- How much time does your doctor expect you to be out?
- Does your doctor anticipate you being released back to duty?
- Can you sit down and for how long?
- Can you stand and for how long?
- Can you bend or reach overhead?
If your doctor says that you cannot do any of these tasks and does not expect you to be able to work in the near future, you may have a case for long term disability benefits. However, a note from the doctor will not be sufficient evidence to win your claim for long term disability benefits.
Why Was My Claim Denied?
It is important to know the most common reasons LTD claims are denied:
- Incomplete Medical Information. One of the most common reasons claims are denied is due to missing or incomplete medical information. Forgetting to list a doctor’s office address or listing an incorrect address means the insurance could not verify your medical information. Forgetting to list all of your doctors and medications can also cause a denial.
- Missed Appointments. When you are sick and not working, it can become difficult to make doctor’s appointments; especially if you are required to make a co-pay each visit. However, the insurance company will say that you do not need medical attention if you are missing appointments. It’s very important to make all doctor’s appointments as scheduled.
- Doctor’s Notes. It is very common for doctors to only write down the clinical symptoms and not make notes regarding pain, depression, low energy level, etc. Be sure that your doctor documents this in your file as proof that you are suffering from these symptoms as well.
What Do I Do Now?
It depends on the language of your disability policy. For that reason alone, you should seek legal advice from an experienced disability insurance attorney. You don’t want to make the mistake of appealing the claim on your own when it may not even be necessary. Some policies require an appeal before litigation and others do not.
If you do need to file an appeal, gather the documents that you need from your doctor, including a residual functional capacity report. This will help outline the tasks that the doctor believes you are not able to do safely without injuring yourself further. Make yourself a copy, and then submit them to the insurance company yourself. Note: There may be a fee from your doctor’s office for completing forms.
A long term disability attorney can assist you by gathering all the documentation needed to support your claim. They can also ensure that you do not miss any important deadlines. For these reasons, you should seriously consider contacting an experienced attorney before you make a terrible claim or appeal mistake.
If you’d like to discuss your claim with a long term disability insurance attorney, contact us at (888) 321-8131 to schedule a free case evaluation. We represent claimants anywhere in the country and can help you determine how to move forward with the process.