5 Mistakes People Make When Filing For ERISA Long-Term Disability
What are the top five reasons a long-term disability application might be denied?
My name is Brandon Osterbind, and I am an injury and disability attorney here in Central Virginia. I work with people whose long-term disability claims have been denied by an insurance company and I help them get what we call on claim. This means I help them get their benefits from their insurance policy.
A lot of times, we see the same explanations for why a claim has been denied. And I thought I would give you the top five reasons why your claim may have been denied.
Lack of medical documentation
The first one and the one we see most often is a lack of medical documentation. That’s a fancy way of saying, “There is simply not enough information in the medical records for us to give you your disability benefits.”
No objective evidence of disability
The second reason is that there is no objective evidence of a disability. For example, chronic pain issues or maybe mental health issues or diagnoses are often subjective complaints. And sometimes there are tests that you can do that will objectively verify those symptoms and sometimes there aren’t.
Some of the insurance companies will say, “We don’t require objective medical evidence.” But they will – wink, wink, nod, nod – say that, “You don’t have any medical evidence for us to give you benefits.”
The doctor said you’re not disabled
The third reason why a lot of insurance companies deny long-term disability claims is because their doctor has said that you are not disabled. And when they do that, half the time, the doctors will have never even seen you. They will review your medical records that are, once again, probably insufficient. And they will say that based on their medical opinion, you are not unable to perform the occupation that you were performing before.
You have a light-duty job
The fourth reason why we often see medical denials is because you have what they call a sedentary job or a light-duty job and your limitations are perhaps not physical limitations. Or maybe your limitations are physical limitations but they still allow you to do the job that you were doing before.
Most insurance policies have what they call an “own occupation” period and they are based almost entirely on what your job was. The insurance company will look at your job description and compare it to your job description as it would relate to perhaps the national economy and they will say, “Well, how do these restrictions line up with these job duties?”
And if they still permit the duties of the job, then the insurance company will say that you are not disabled. It’s really important what your job description is and comparing that job description to your physical or your mental or cognitive limitations.
It’s also important to have a doctor or a medical professional look at those things because, ultimately, it’s up to your doctor as to whether or not you can perform those particular tasks.
The claim (or appeal) is filed too late
And the fifth and last reason why we often see long-term disability claims being denied is because they are filed too late. You have what is called an elimination period that you have to wait during your short-term disability period when you are then required to file your long-term disability period. You have to give the insurance company a certain period of notice.
All of this should be in your long-term disability insurance policy. And your claims representative or perhaps your human resources department should provide you with that information so that you know what those deadlines are. But we often see that a claim has been filed too late. Or we see that the claim has been filed on time but the claim was not appealed on time.
What you should do
You have 180 days after your claim has been denied to file your appeal. It’s like a statute of limitations. And if you don’t file your appeal in time, your claim is essentially dead in the water.
If you’re getting close to that 180 days deadline, now is the time to act. You can’t sit on your hands any longer. Because if you do and then you turn around and try to file your appeal, your claim will ultimately be denied.
Those are the top five reasons why most insurance companies will deny a long-term disability claim. If you have a question about any one of those items or if your long-term disability claim has been denied, give us a call or send us an email. We’d be happy to review the denial letter that you received for free and give you a strategy to try to attack that denial letter on the appeal.
