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Why Were My Long-Term Disability Benefits Denied?

On Behalf of | Jul 24, 2019 | Firm News

Pittsburgh long-term disability lawyers help clients with disability benefits claim denials.

Long-term disability benefits provide much needed compensation for individuals with chronic illnesses or disabling injuries that can no longer work. While most long-term disability policies are provided by an employer, independent policies are also available. In some cases, benefits are initially denied, but benefits can still be awarded through an appeals process.

It is not uncommon for long-term disability benefits to be denied. Insurance carriers typically try to delay the application processing and attempt to settle for a benefit that is far less than what the disabled individual qualifies to receive.  When benefits are denied, the appeals process can be overwhelming to the average person. The most common reasons for a denial of long-term disability benefits include:

  • Lack of medical evidence
  • Missed deadlines
  • Conditions not included in the policy
  • Pre-existing conditions and exclusions
  • Investigative evidence inconsistent with diagnosis
  • Insurance company disagrees that medical condition prevents working
  • Errors and submission of information in claim application
  • Not knowing what the administrative record of the insurance company contains

Appealing a Denial of Long-Term Disability Benefits

It is always wise to consult with a long-term disability lawyer before submitting a claim for benefits, but if your application has been denied, it is imperative to seek legal counsel. Strict deadlines, crucial evidence, and knowledge of insurance tactics and linguistics can all play a key role in the success of an appeal for benefits. An experienced long-term disability lawyer can ensure that your legal rights are protected, and you claim the maximum amount of compensation available.

Long-term disability insurance is regulated by the federal Employee Retirement Income Security Act (ERISA) of 1974. This law allows individuals to sue their employers for benefits that are initially denied. The law is specific and has terms and conditions that must be met. In this type of lawsuit, the defendant has an advantage because they need very little evidence to prove their denial. The plaintiff has the burden of proof and therefore must come prepared with a vast amount of medical documentation to support their claim.

If you have been denied long-term disability benefits, you will need the following evidence to present in your appeal:

  • Medical records of ongoing doctor visits, physical or cognitive therapies, prescription medications, surgeries, psychological evaluation or treatment, hospitalizations, and assisted living equipment, such as wheelchairs, scooters, and canes.
  • A detailed statement from a medical professional that outlines your diagnosis and the limitations that the illness or injury places on your ability to work.
  • Copies of paperwork submitted during the claims process that proves you met all required deadlines.
  • Your date of diagnosis for your disability and your last day of work.

Your long-term disability lawyer can ensure that your evidence is strong and can stand up against the insurance carriers that want to limit or deny your compensation.

Further, the record that is developed during the administrative processing by the insurance company is the only record that will be reviewed by the federal court should you have to sue the insurance company.  That is why it is crucial that an experience attorney help you with your claim and appeal so that the record is complete should you have to sue.

Pittsburgh Long-Term Disability Lawyers at AlpernSchubert P.C. Help Clients with Disability Benefit Denials Claim Compensation

If you have been denied long term disability benefits, do not give up. The Pittsburgh long-term disability lawyers at AlpernSchubert P.C. can help you claim the maximum amount of compensation you are entitled to receive, even when your benefits have been denied. Call us at 412-765-1888 or contact us online to schedule a free consultation today. Located in Pittsburgh, we serve clients throughout Allegheny County, Lawrence County, Washington County, and western Pennsylvania.