Long-term disability insurance provides an individual with 50 to 80 percent of their salary when they are unable to work due to illness or injury. Unlike Workers’ Compensation insurance, long-term disability insurance is provided whether the illness or injury was work-related or happened independently from the job. While individuals can buy personal long-term disability policies, this benefit is most often provided by an employer.
Long-term disability benefits are pivotal in helping permanently disabled or chronically ill people stay on top of their medical bills and personal costs of living, which include rent and mortgages, car payments, medical and car insurance, and food for their family. Unfortunately, many long-term disability providers try to deny benefits or seek a settlement that is much less than what an individual is entitled to receive.
Long-Term Disability Policy Deadlines and Regulations
One of the first areas of difficulty in claiming long-term disability benefits comes with meeting the stringent deadlines and regulations for filing a claim. Employers and long-term disability providers often work to delay applications while using industry specific language to deny claims and reduce settlements. A qualified and experienced long-term disability lawyer knows the laws surrounding this type of insurance and can ensure that filing deadlines are met and medical evidence is available to support a claim.
Employer sponsored long-term disability insurance is governed by the federal Employee Retirement Income Security Act (ERISA). This federal law allows disabled individuals who are denied long-term disability benefits to sue their employer in federal court. Knowledge and understanding of this law can be difficult for the average person to comprehend, and mistakes made when filing a claim or disputing a denial of benefits can be hard to overcome. Insurance companies are not required to provide much evidence to support their denial of benefits, so crucial evidence must be provided by the plaintiff to prove their medical status.
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.
Reasons for Denial of Long-Term Disability Benefits
Being aware of the common reasons for a denial of long-term disability benefits can help claimants avoid delays and appeals, which include:
- Lack of Medical Evidence: Records of ongoing doctor visits, physical or cognitive therapies, and diagnostic testing are pivotal in proving the severity of the claimant’s illness or injuries.
- Medical Diagnosis: It is imperative to have a medical professional’s detailed diagnosis on file to substantiate a claim for long-term disability benefits. The statement should include specific limitations that the illness or injury places on the individual that prevents them from working.
- Disability Policy Limitations: Long-term disability policies have specific conditions and illnesses that they will cover. Failure to meet these stipulations can lead to denial of benefits.
- Missed Deadlines: Deadlines for filing claims and appeals and for submitting evidence are strict. Failure to meet these deadlines can result in a permanent denial of benefits.
- Investigative Evidence: Insurance companies typically hire private investigators to follow those claiming long-term disability benefits to prove that their medical conditions are not as serious as indicated in their claim. Video surveillance, photographs, and witness testimony can be used against plaintiffs. Benefits can be denied and previously awarded benefits can be terminated.
Long-Term Disability Claims Process
Success in filing for long-term disability benefits depends on the claimant’s attention to following the claims process.
- Understand the conditions covered under your policy and stipulations for approval.
- Determine the specific date of disability, which will be used to set filing deadlines along the claims process.
- Choose your last day of work carefully. Be sure that medical records exist that confirm your illness or injury before going off of work due to your medical condition.
- Identify all required deadlines and make plans to satisfy the requirements of the insurance policy.
- Gather pertinent medical records from the date of disability and throughout the claims process.
- Obtaining the claim file and other documentation from the insurance carrier so that you know what they did in reviewing the medical evidence and how to respond to the issues raised in the denial.
Pittsburgh Long-Term Disability Lawyers at AlpernSchubert P.C. Represent Those Seeking or Appealing Long-Term Disability Benefits
If you need to apply for long-term disability benefits, or if you have been denied long-term disability benefits, the Pittsburgh long-term disability lawyers at AlpernSchubert P.C. can help you claim the maximum amount of compensation you are entitled to receive. Call us today 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.