UnitedHealthcare and Long Term Disability – Appeal of a Denial Letter

Hi, I’m Nick Ortiz. I’m a board certified disability insurance attorney. Today I’m here to talk to you about UnitedHealthcare and long term disability claims.

You’re probably here today because UnitedHealthcare has either unreasonably delayed in making a decision on your claim or they have denied your case or wrongfully terminated your benefits.

There are several reasons why UnitedHealthcare may have denied your claim.

First and foremost is they had your file reviewed by one of their doctors. And their doctor says that you do not have very significant limitations. And their findings may be very different from your doctor’s. And the insurance company will use the findings of this report against you in saying that your condition is not so severe and therefore you’re able to work.

A second reason why your claim may have bene denied is that they had your file reviewed by vocational expert, which is a job expert. And this job expert may have concluded that based upon your medical records and your work history that you can still do either your work or other types of work. And if the vocational expert has these findings, then the insurance company will use those findings against you.

A third reason why UnitedHealthcare may have denied your claim is because of a change in the definition of the term disability. Under most of group plans, the term disability or disabled or totally disabled changes after two years. See, under most policies, you’re deemed disabled so long as you cannot perform the material duties of your job, or what we call your own occupation. And that’s different than whether you can perform the material duties of really any job, or any occupation. So a lot of insurance companies, including UnitedHealthcare, they’ll say that: “we understand that you cannot do the material duties “of your job, but we think there’s other work that you could do.” And therefore, when that definition changes, typically after two years, that is a natural cut off point where they terminate a lot of benefits, is at the two year mark.

A fourth reason why the insurance company may have denied your claim is because they say that there is insufficient medical evidence to support the claim. What that means is one of a couple different things. That maybe they looked at all the medical records and they just don’t think your condition is severe enough to keep you from being able to work. But, the other thing is, they may not have all your medical records. And therefore, if they don’t have all your medical records, they may not have all the evidence they need to make a finding of disability. And that’s one thing that we can help you do is make sure that the insurance company has all the medical records to make the right decision.

But a fifth reason why the insurance company may deny your claim is due to surveillance. And surveillance can be conducted in one of two ways. One is by covert video surveillance. And what that means is they may have hired a private investigator to come out and follow you around and record your activity and they may say that the activity on that video recording is inconsistent with a disability. But in today’s day and age, there’s another way of conducting surveillance and that is to track you on social media. You can rest assured that the insurance company is looking up information about you on Facebook and Twitter and Snapchat and pretty much any other form of social media and they may say that your postings there are inconsistent with a disability.

Another reason why you might be here is because the insurance company is just taking way too long to issue a decision. They may have gone beyond the statutory time limits and therefore, their time to make a decision is just up. And if that’s the case then we encourage you to give us a call to go over your legal rights.

So, regardless as to whether your claim was denied or delayed then we encourage you to call us at 850-898-9904 to go over your legal rights.

If you don’t want to talk to someone right away but you want to get some more information then I do encourage you to download a free digital copy of a book that I wrote called: The Top 10 Mistakes That Will Destroy Your Long Term Disability Claim. You can download a free copy of the book at www.freeltdbook.com. We look forward to hearing from you.