Denied Long-Term Disability Benefits? Your Legal Options

Long-term disability (LTD) insurance provides financial benefits for individuals unable to work for six months or longer due to serious injury or illness. Unfortunately, many LTD claims are initially denied by insurance companies that are trying to save money, leaving injured workers and their families without the compensation they need.

If your LTD claim was denied in Pennsylvania, it’s crucial that you understand your legal options. You can appeal the insurance company’s decision or file a lawsuit seeking payment of the benefits you’re entitled to.

Why Are Long-Term Disability Claims Denied?

Insurance companies want to deny long-term disability claims because it saves them money. They’re businesses that want to protect their bottom line. However, insurers must provide claimants with a reason for their denial, and the following are some of the most common reasons:

• Insufficient Medical Evidence – The insurer may claim that the medical evidence presented with your claim doesn’t prove that your medical condition impacts your ability to work enough to trigger your policy’s coverage.
• Policy Exclusions – The insurer may claim that your particular condition is excluded under the terms of your LTD policy.
• Insurer Surveillance – The insurer may hire an investigator to follow you around or comb through your social media accounts to find “evidence” that your condition isn’t as severe as you claim.
• Independent Medical Examinations – The insurer may request that you undergo an independent medical examination to verify the extent and severity of your condition. Despite the name, these medical examinations are rarely independent, and the reports may downplay your symptoms.

What to Do If Your Long-Term Disability Claim Is Denied

If the insurer denies your LTD claim, some of the critical steps you should take include reviewing the denial letter, filing an appeal with the insurance provider, and considering filing a lawsuit.

Review the Denial Letter

The first step is always to review the denial letter you received from the insurer. Under 29 U.S. Code Section 1133(1), insurers must outline the specific reasons for the denial in a way the claimant can easily understand. Reviewing this letter will inform you of what changes to make or additional evidence to add to your claim when filing an appeal. An experienced disability lawyer can also assist by reviewing the letter and answering any questions you have.

Based on the denial letter, you may need to include the following in your appeal:

• Updated medical records that include more test results
• Notes from your doctor explaining your condition in more detail
• Expert testimony regarding the vocational impact of your condition

File an Appeal

Once you’ve determined why the insurance company denied your claim and made the appropriate updates, it’s time to file your appeal. Under the Employee Retirement Income Security Act (ERISA), you have at least 180 days to file an appeal after a claim denial. Depending on your LTD policy, you may have additional time, and a lawyer can help you determine your exact time limit.

Upon filing your appeal, the insurance company must have someone other than the person who denied your claim review all of the information you provided and perform a thorough investigation. The insurer has an initial 45-day period to conduct this investigation, but may seek an additional 45 days if it notifies you of the reason in writing.

File a Lawsuit

If your appeal is denied, you can file a lawsuit against the insurer if you believe it did not follow the proper claims procedure or fairly investigate your claim. Through your lawsuit, a judge will review all of the evidence submitted during your initial claim and appeal, making it essential to submit as much evidence as possible earlier in the process.

How a Pennsylvania Disability Attorney Can Help

When appealing a denied LTD claim or filing a lawsuit, it’s recommended that you work with an experienced disability attorney. Your attorney can handle all aspects of your case, including:

• Reviewing the denial letter to identify weaknesses in the insurer’s reasoning and determine what new evidence to provide
• Keeping track of the timeline of your case, filing the appeal within the time period, and holding the insurer to their deadlines
• Negotiating with the insurance company on your behalf
• Filing your lawsuit and representing you in court if necessary

Contact Our Long-Term Disability Attorneys

If your long-term disability claim was denied in Pennsylvania, contact Capitan Law at (267) 419-7888 for a free consultation with an experienced disability attorney. We’ll review the reason for your claim denial, go over your options, and help you take the next steps toward seeking the benefits you need.