Everyone assumes their long-term disability insurance will be there when they need it. That’s why it’s such a shock when claims are denied. If you’re suffering from a long-term injury or illness, your disability benefits are likely an important source of income, helping to keep your life on track as you recover from an injury or illness. A denial of your claim is confusing and frustrating, but you have options. If your claim has been denied, a Philadelphia long-term disability denial lawyer can help you fight for the benefits you are entitled to.

Reasons Long-Term Disability Insurance Applications Get Denied

Long-term disability insurance is a private source of insurance (as opposed to Social Security) that pays benefits when you are unable to work for an extended period of time. 

Unfortunately, your benefits are not automatically paid upon becoming disabled. You are required to submit a properly documented claim that is then reviewed by your insurance company. The insurance company will then either approve or deny your claim. Sometimes, your long-term disability claim is denied even if you received your short-term disability benefits. 

Common reasons a long-term disability insurance claim is denied include failing to meet your policy’s definition of “disabled,” failing to provide required documentation, and filing a claim for an excluded condition. A Philadelphia long-term disability denial lawyer can help you appeal your claim denial for each of these reasons and more.

You Don’t Meet Your Policy’s Definition of Disabled

Long-term disability policies have a specific definition of disability that can vary from policy to policy. Regardless of whether or not you can work, if you do not meet the definition of disabled under your specific policy, your claim will almost certainly be denied. 

The key component in determining whether you meet your policy’s definition of disabled is whether you have an “own occupation” or “any occupation” policy. 

  • An “own occupation” policy defines disability to mean that you are unable to perform the material and substantial duties, or principal duties, of your regular occupation. For example, a surgeon who suffers extensive nerve damage in his hands due to a car accident may be considered disabled because he can no longer perform surgeries. 
  • An “any occupation” policy defines disability to mean that you are unable to perform any job for which you are qualified. Under an “any occupation” policy, a surgeon would not be considered “disabled” if they are able to work in some other capacity. 

Many policies will change from an “own occupation” standard to an “any occupation standard” after a standard period of time, typically 24 months. At that point, your disability benefits may be terminated because you no longer meet the definition of disability. A Philadelphia long-term disability denial lawyer can review your policy, evaluate whether you qualify for benefits, and determine whether you were wrongfully denied coverage. 

A Lack of Medical Documentation Can Get Your LTD Claim Denied

If you have to make a claim under your long-term disability policy, the supporting medical records will be critical to getting your claim approved. Your insurance comply will likely request the following:

  • Medical records surrounding your disability. Of course, the insurance company will want to see your medical records documenting your injury or illness. Even if it may be obvious, they will not approve your claim on the basis of a self-diagnosis. More importantly, your records should show that you are under the regular care of a physician for your injury or illness. As a Seltzer & Associates Philadelphia long-term disability denial lawyer can attest, many claims are denied because the claimant stopped seeking appropriate medical treatment after the initial diagnosis. 
  • Treating physician’s statement. Perhaps most importantly, your doctor’s opinion regarding your disability will be scrutinized by your insurance company. As a result, it should be as detailed as possible – it should provide an explanation of the extent of your disability, whether you will recover and how long it will take, the recommended treatment, and how it will affect your ability to work. Your doctor should complete the form provided by your insurance company to document their opinion – however, these forms are often designed to limit pertinent information.  A treating doctor completing the form should do so by providing all important medical information relevant to your claim, even if it requires exceeding the space provided per question, so as not to result in a denial. 

Insurance companies often deny claims on the basis that they received insufficient medical information. As a result, ask your insurance company for a list of the documents they will need to review your claim. You should also plan on periodically checking with them to see which records they have and which records they do not have, in order to help them get the records they need. 

It’s also important to note that your insurance company has its own doctors that will review your claim. Unfortunately, those doctors may disagree with your doctor’s diagnoses, resulting in the denial of your claim, which is why it is important for your doctor to be as detailed as possible in their diagnoses and medical basis relied upon to support the diagnoses. 

Check with a Philadelphia Long-Term Disability Denial Lawyer First so You Don’t Claim an Excluded Condition

Long-term disability policies typically include various exclusions and limitations. Pre-existing conditions typically can include any medical condition for which you received treatment within 3 months prior to the effective date of coverage and which disabled you within 12 months of the effective date of coverage. If you raised your claim based upon this pre-existing condition, your claim will most likely be denied. Other common exclusions include disabilities due to self-harm, suicide attempts or commission of a crime. 

Your policy will likely also include several limitations.  Disabilities involving mental conditions such as anxiety or depression may be limited to only 24 months of coverage.  Disabilities based upon Drug Addiction or Alcoholism may be limited to only 24 months. A Philadelphia long-term disability denial lawyer can review your policy and determine whether your claim was wrongfully denied. 

Your Insurance Company Does Not Have the Final Say 

You don’t have to accept your insurance company’s denial of your claim. Insurance companies wrongly deny claims on a regular basis, often for cursory reasons and in an attempt to protect their bottom line. A Philadelphia long-term disability denial lawyer at our firm can evaluate whether your claim has been wrongfully denied and help you navigate the process to get the disability insurance benefits you deserve. 

Contact a Philadelphia Long-Term Disability Denial Lawyer Today

If you’re unable to work due to illness or injury, dealing with a denial of your long-term disability claim can be overwhelming. The process is complicated and the reasons for your denial may be unclear. The attorneys at Seltzer & Associates can help you understand your policy and your options to get the benefits you need. Contact us at 888-699-4222 to schedule a free consultation with our legal team. We handle long-term disability claims and cases against all long-term disability carriers nationally, in Philadelphia and throughout the United States.