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Long-Term Disability Claims & Appeals: FAQs

June 26, 2017

Long-Term Disability Claims & Appeals: FAQs

Long-Term Disability Claims & Appeals: FAQs

Navigating the long-term disability (LTD) claims process can be challenging, especially in light of the fact that insurance companies are not necessarily looking out for policyholders or their rights. In fact, some insurance providers may even take extra steps – like surveilling claimants – to try to find reasons to deny claims.

Important Answers about LTD Claims

To start to understand what can be done to protect your rights to benefits and overcome these challenges, we have answered some of the most commonly asked questions about LTD claims and appeals.

When you are ready to receive more information specific to you and your circumstances/claim, simply contact Denver Disability Lawyer Shawn E. McDermott.

Q – When should I file an LTD claim?

A – First, you need to understand your coverage.  Read your employer plan or insurance policy and, specifically, the definition of disability.  When you have a disabling condition that qualifies as a long-term disability, it’s typically recommended that you file an LTD claim as soon as possible. This is because LTD policies commonly require policyholders to submit LTD claims within a specific period of time from the onset of the impairment.

The terms of your LTD policy should explain these deadlines (as well as what constitutes a long-term disability).  An attorney can help you decipher these terms (and even help you file a claim).

Q – How do I file an LTD claim?

A – Different insurance providers may have a specific or unique process for filing LTD claims, and your policy documents should provide details about what you must do to initiate a claim (i.e., the claims filing procedures).

In general, however, the LTD claims process starts by completing and submitting the appropriate claim forms to the insurance company. As part of this process, it’s usually also necessary to provide the insurance company with:

  • A statement from the diagnosing/treating physician
  • Copies of medical records
  • A statement from an employer and/or a job description
  • An authorized release form to allow the insurer to access your sensitive medical records

The insurance provider may request additional information.

Q – Why was my LTD claim denied?

A – We cannot answer this question without first reviewing your claim and understanding your situation. What we can tell you is that some of the more common reasons that insurance companies deny LTD claims include that:

  • There was a failure to prove the presence of an LTD (maybe, for instance, because medical records were not submitted).
  • The disability constitutes a pre-existing condition, which is not covered by the LTD policy.
  • The elimination period has not been fulfilled.
  • The claimant is not receiving care from a doctor.
  • Most often, the insurance company will simply conclude that the medical evidence fails to establish that your restrictions and limitations are significant enough to render you unable to perform the material duties of your (or any) occupation.

It’s not uncommon for insurers to wrongly deny LTD claims or to state dubious grounds for issuing denials. That is why it’s critical to consult a lawyer if your LTD claim has been denied. An attorney can explain whether an insurance company may have made a mistake, issues a wrongful denial, or otherwise denied your valid claim.

Q – What can I do if my LTD claim has been denied?

A – Carefully read the denial letter to see the reasons cited by the insurance company for the denial, and look over the terms of your plan to find out how to pursue an appeal or reconsideration request (if there’s reason to believe the insurance company made the wrong decision).

There are usually strict deadlines for filing LTD claim appeals, so it’s best to move forward ASAP with an appeal after a claim has been denied, and usually with the assistance of a lawyer.  As discussed elsewhere on our website, the internal appeal of a denied LTD claim is considered the most crucial step in the process.  The importance of having an experienced lawyer assist you through this process cannot be understated.

Q – Do I have any options if my appeal is denied?

A – If the appeal is denied and all of the administrative remedies have been exhausted, claimants may be able to move forward with a civil suit against the insurance company. At this point, having the representation of an experienced disability lawyer – like Attorney Shawn E. McDermott – can be pivotal to effectively standing up to the insurance company and securing benefits.

Q – How can a lawyer help me with an LTD claim or denial?

A – An attorney can help you with LTD claims and/or appeals in various ways, including (but not limited to) by:

  • Helping you decipher the terms of your LTD policy
  • Submitting all necessary documents to initiate the claim
  • Protecting your rights in all dealings with insurance companies
  • Taking care of all of the administrative work necessary to position your claim/appeal for favorable results
  • Fighting back when insurers wrongly deny your claim.

Receive More Answers Now: Contact Denver Disability Lawyer Shawn E. McDermott

For experienced help pursuing an LTD claim and/or appeal, contact Denver Disability Lawyer Shawn E. McDermott. Dedicated and experienced, Shawn McDermott has a record of success when it comes to helping people stand up to insurers and secure the full amount of benefits to which they are entitled.

Call us at (303) 964-1800 or email us using the contact form on this page to set up a complimentary consult during which you can learn more about how Attorney Shawn E. McDermott Law can help you.

From our offices in Denver, we provide the highest quality legal services to disabled people throughout the state of Colorado, the surrounding states and nationwide.

Categories: Colorado, Denial of Benefits, Disability, Long-Term Disability Benefits, Long-Term Disability Claims


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