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Being told by your doctor that you can no longer work, only to have your long-term disability (LTD) claim denied, is both frustrating and confusing. In this post, we’ll help you understand why these denials happen and provide actionable steps to resolve the issue.
Evidence Needed to Support Your Claim
The documentation you submit to support your long-term disability claim is called your “administrative file.” Everything relevant to your claim must be included, including any documentation you wish to submit as proof of your disability.
Long-term disability insurance companies require an unbiased opinion and concrete evidence that you cannot work before they will approve your LTD claim. In addition to medical and lab reports, insurance companies want answers to the following questions:
- How long does your doctor expect you to be out of work?
- Does your doctor expect you to return to work?
- Can you sit down, and for how long?
- Can you stand, and for how long?
- Can you bend or reach overhead?
If your doctor indicates that you cannot perform 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 simple note from your doctor is not enough evidence to win your claim.
Why Was My Claim Denied?
Understanding the most common reasons LTD claims are denied can help you address potential problems:
- Incomplete Medical Information: One of the most common reasons for denial is missing or incomplete medical information. Forgetting to list a doctor’s office address or listing an incorrect address means the insurance company cannot verify your medical information. Forgetting to list all your doctors and medications can also result in a denial.
- Missed Appointments: When you are sick and not working, it can be a challenge to keep all your doctor’s appointments, especially if each visit requires a co-pay. However, the insurance company may argue that you do not need medical care if you miss appointments. It’s important to keep all scheduled appointments.
- Doctor’s Notes: Doctors often document only clinical symptoms and may not note pain, depression, low energy levels, etc. Make sure your doctor includes these details in your file to provide a comprehensive record of your condition.
What Do I Do Now?
Your next steps will depend on the language of your disability policy. For this reason alone, you should seek legal advice from an experienced disability insurance attorney. Avoid appealing the denial on your own if it may not be necessary. Some policies require an appeal before a lawsuit, while others do not.
If an appeal is necessary, gather the necessary documentation from your doctor, including a residual functional capacity report. This report outlines the tasks your doctor believes you cannot safely perform without risking further injury. Make a copy for yourself and send it to the insurance company. Note that your doctor’s office may charge a fee for completing these forms.
A long-term disability attorney can help you gather all the necessary documentation to support your claim and ensure that you do not miss any important deadlines. For these reasons, you should consider contacting an experienced attorney.
If you’d like to discuss your claim with long-term disability insurance attorney Nick Ortiz, call us at (888) 321-8131 to schedule a free case evaluation. We represent claimants nationwide and can help you determine how to move forward with the process.
