In the event that a worker becomes disabled and unable to execute his or her job obligations, an employer will frequently provide long-term disability (LTD) insurance.
To bridge the gap when an employer does not provide a sponsored LTD plan, employees might acquire LTD plans from a private insurer.
In the event of a disability, you expect your long-term disability insurance (LTD) to kick in and compensate for your missed payments, even if it’s simply a guaranteed portion of your usual salary.
When it comes to making a claim on LTD plans, many people are surprised. Oftentimes, employees have been paying their premiums on a monthly basis for years before filing a claim for disability benefits with assistance from their doctors. A letter refusing benefits may be sent to employees instead for a variety of reasons, the most common of which is a lack of “adequate medical proof” as defined by the insurer. What’s next? Is there anything you can do to help an employee who is facing a total loss of income as a result of their disability?
Additionally, our attorneys can assist employees in avoiding some of the common mistakes that lead to disability claims being denied. There is a process for appealing a decision if you’ve been rejected. Disability insurance lawyers from our firm can assist you in presenting the strongest facts and arguments to convince the insurance company to honor its commitment to pay payments.
Reasons for Denials of LTD Claims
Lack of appropriate medical evidence is, as previously said, probably the most common reason for an LTD claim refusal. The type of disability you have will determine whether or not you need to submit X-rays, MRIs, or other imaging tests to support the initial claim you submit. Do not forget to include documents of any medical treatment you’ve had.
You may be required to undergo an independent medical examination (IME) by an insurer’s choice of physician or medical group if the insurer is uncertain about your health status. You run the risk of having your disability benefits claim denied if you refuse or fail to submit to the IME.
Another reason for refusal is that you did not submit your claim and documents in a timely manner in the eyes of the insurer. Clauses in most policies specify the timeframe in which you must notify the insurer of your claim, as well as severe conditions for doing so. It’s possible that you won’t be able to sue the insurer if you don’t file an appeal in time, so make sure you don’t miss the opportunity to do so.
Consult with Reputable Lawyers for Long-Term Disability
The simple reason is that insurers have an incentive to dispute every claim and restrict liabilities since they are in the business of making money. It’s understandable that some people would rather deny than admit they’re wrong.
It’s critical that you provide the insurance company with evidence that proves the condition that’s causing your disability and incapacity to work so that they don’t deny your claim. An experienced legal team can make all the difference in a case like this. And the higher the specialization, the better. For instance, you need the help of a boat accident injury lawyer if your disability appeared after a boating accident.