Long-Term Disability Denial


You may be wondering what you should do if you find yourself in the situation where you have a long-term disability policy and have reached a point where you need to file a claim, only to have the insurance company give a denial on your claim. But what should you do next? And what’s this disability insurance thing all about?

What is a disability insurance policy and what is it for?

Disability insurance policies are most often seen as an employee benefit that is offered as a perk to employment with a job. Just like employee benefit packages often offer health insurance or dental insurance, sometimes they will offer disability insurance. If offered and elected, the disability insurance policy covers the insured party under the terms of the plan documents that were agreed upon by the insurance provider and your employer. The premiums are usually taken out of the insured’s paycheck, just like health and dental insurance premiums. Sometimes the employer pays the premium. The disability insurance policy is in place to cover the insured in the event that they become unable to work, usually due to their medical conditions.

Why would an insurance company deny benefits that I paid for when I’m clearly not able to work?

Disability insurance companies are in the business to make money. While they do pay claims, we see a lot of valid claims denied. Insurance companies often argue that the claimant is not disabled to a degree that would prevent them from working, and deny the claim. When you pay your premiums, you are simply paying for the policy that you have in place. It’s important to understand your premiums are not banking or saving up. Someone who goes out of work after having a policy for three years is seen no differently than someone who has paid their policy premiums for fifteen years.

Why did the insurance company deny my disability when my doctors told them I can’t work?

Having your doctors support your disability is the first step to any claim for disability insurance benefits. But just because your own doctors say you cannot work doesn’t mean you’re guaranteed to receive benefits. The insurance company will use their doctors to review your medical records and provide a report as to whether or not they agree you are disabled. Unfortunately, sometimes these doctors disagree. Having support from your doctors before, during, and after you file for disability is important to show continued treatment and treating physician opinions of disability that are unaltered by what the insurance company and their doctors say are always helpful.

I received a denial letter from the insurance company. What should I do now?

Your denial letter will lay out what the process is and if you have an appeal available. But before you fire off that appeal, STOP! Now is the time to consider hiring an experienced disability insurance attorney. Sometimes you may have more than one appeal available, but once you run out of appeals, the only recourse is to file a lawsuit against the insurance company. So why should you contact an attorney now? If you receive a final denial and have to file a lawsuit, the only evidence that will be admissible in an ERISA case is what is in your claim file. And the only evidence that will be in your claim file is what was added to that file before it closed and ERISA cases close with the denial of the last appeal. In other words, what was sent to the insurance company before they made a final denial. This is why it’s important to have a knowledgeable attorney handle your appeal and me sure that your case is strong enough should you need to file a lawsuit.

What should I do with a final denial letter from an insurance company? It says something about administrative remedies have been exhausted.

Administrative remedies being exhausted simply means that you trying to work out the disagreement about whether you are disabled or not with the insurance company is now over. Your denial letter should state that you have the right to bring legal action. This means that if you wish to pursue the matter, you must now sue the insurance company for the benefits you’re seeking. We have represented many clients who have come to us with a final denial and have been able to get them money.

If you have a denial letter from a disability insurance company, give us a call to see if we can help with your appeal or your lawsuit!