Don’t Face a Denial Alone. Contact a Philadelphia Long-Term Disability Denial Lawyer Today

Insureds often assume long-term disability insurance coverage will secure them when they need it most. After all, the premiums have been paid as specified, and the policy is in effect. Long-term disability insurance benefits are a financial resource that an insured generally expects to be available for qualifying sickness or injury. The denial of your claim can cause immediate shock and financial hardship. If you’re suffering from a long-term injury or illness, your disability benefits are likely a critical source of income, helping to keep your life on track as you address the injury or illness. Claim denials will be confusing and frustrating, but you do have options. If your claim has been denied, a Philadelphia long-term disability denial lawyer can help you fight for any disability benefits you are due.

Our Philadelphia Long-Term Disability Denial Attorneys Explains Reasons Insurance Applications Get Denied

Long-term disability insurance is a private, individual or employer-sponsored source of coverage (unlike public programs such as Social Security Disability) that should pay benefits when you are unable to work for an extended period of time due to eligible illness or injury. 

Unfortunately, disability benefits are not guaranteed payments and automatically paid upon becoming disabled. You must submit a properly documented claim for review by your insurance company. The insurer will ultimately approve or deny your claim. It is worth noting that receipt of short-term disability benefits will not guarantee eligibility for long-term disability benefits, even if both coverages are administered by the same company. 

Transitioning from a short-term disability insurance claim to a long-term disability insurance claim can be complicated. You might assume that your disability insurance company has the medical evidence necessary to continue payments under your long-term disability insurance policy when the short-term disability period is exhausted. However, the short-term and long-term disability plans are different policies containing different terms and requirements to prove disability insurance coverage. If your long-term disability insurance claim is denied, your Philadelphia disability denial lawyer can help you appeal the insurance company’s decision.

Common reasons a long-term disability insurance claims are denied include failing to meet your policy’s definition of “Disability,” failing to provide sufficient documentation, and/or filing a claim for an excluded condition. A Philadelphia long-term disability denial lawyer can help you appeal a claim denial for any reason.

You Don’t Meet Your Policy’s Definition of Total or Residual Disability

Long-term disability policies have specific definitions of Disability that can vary from one policy to the next. Regardless of whether or not you can work, if you do not meet the definition of Disability or Disabled under your specific policy, your claim will be denied. 

A key distinction among policy terms is whether you must be Disabled from your “own occupation” or “any occupation” under your policy. 

  • An “own occupation” policy generally defines Disability as an injury or illness rendering you unable to perform the material and substantial duties, or important duties, of your regular occupation. For example, an orthopedic surgeon who suffers extensive nerve damage in his hands due to a car accident may be disabled because he can no longer perform surgeries, even if he can practice medicine in some alternate capacity. 
  • The “any occupation” definition of Disability often means that you must be unable to perform any occupation for which you are qualified based on skill, education, experience and earnings. Under the “any occupation” definition, the same orthopedic surgeon may not be deemed Disabled if he is able to work or is working in some other capacity. 

Many policies will transition from an “own occupation” standard to an “any occupation” standard after a specified period of time, typically 24 months. At that point, your disability benefits may be terminated if you no longer meet a definition of Disability. A Philadelphia long-term disability denial lawyer can review and analyze your policy to assess whether your claim may have been unreasonably denied or terminated. 

If you believe your long-term disability insurance benefits were wrongfully denied or terminated, you should immediately contact a Philadelphia disability denial attorney. The sooner the denial and appeal process are addressed, the sooner any wrongful denial or termination can be remedied.

A Lack of Medical Documentation Can Get Your LTD Claim Denied

When you file a claim under your long-term disability policy, supportive medical information will be critical to getting your claim approved. Your insurance company will likely request the following:

  • Medical records related to your disabling condition. Of course, the insurance company will want to see medical records documenting your injury or illness. Ideally, your medical records would show that you are impaired and under the regular care of a physician for your disabling injury or illness. Your disability insurance company may deny or terminate your disability insurance claim based solely on a lack of evidence of ongoing and/or appropriate care for your disabling condition. While it may be difficult to maintain your medical care appointments due to cost or otherwise, it is imperative that you continue receiving treatment. As a Seltzer & Associates Philadelphia, long-term disability denial lawyer can attest, many claims are denied or terminated because the claimant did not receive appropriate medical treatment after the initial diagnosis. 
  • Attending Physician’s Statement. Your doctors’ opinions regarding your disabling medical condition will be scrutinized by your insurance company. The appropriate treating doctor(s) should complete the form provided by your insurance company to document their opinions – however, these forms often lack pertinent medical information.  It is critical that Attending Physician’s Statements be accurately and thoroughly completed on the claimant’s/patient’s behalf. 

Insurance companies often deny claims on the basis that they received insufficient or unsupportive medical information.  Ultimately, the burden is on you, as the claimant, to provide sufficient proof of your claim. You should methodically document which records the insurer has received and which records they have not to ensure you receive a complete review of your claim. 

It is also important to note that your insurance company will have access to and engae consulting physicians that will review your medical information. Unfortunately, these consulting physicians often disagree with or dispute treatment providers, resulting in the claim denials, which is why it is important for your doctor to explain the medical basis for your claim as strongly as possible. 

Objective medical evidence, if applicable, can greatly help your case. For example, MRIs or x-ray images can demonstrate the severity of an injury or the progression of damage caused by illness or injury. It can also be more difficult to refute objective evidence than subjective evidence, which can provide substantial support for your appeal. 

Check with a Philadelphia Long-Term Disability Denial Lawyer Regarding Policy Exclusions and Limitations

Long-term disability policies may contain various exclusions and limitations regarding coverage. Pre-existing condition exclusions often reference 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 file a claim based upon a pre-existing condition, your claim will likely be denied.  However, pre-existing conditions exclusion can be misinterpreted or misapplied by disability insurance companies. Individual disability insurance policies may specifically exclude conditions by name based on the information disclosed at the time of your application.  It is important that all parties understand and correctly interpret any exclusionary language contained in the policy.  Coverage exclusions generally include, but are not limited to, pre-existing conditions.     

Your policy may also include numerous limitations.  For example, disabilities caused by or contributed to by mental or behavioral conditions such as anxiety or depression may be limited to only 24 months of coverage for the lifetime of the policy.  Disabilities based upon substance use or addiction disorders may also be limited to only 24 months of benefits. However, claimants should not accept the termination of claim based on these limitations without further action, particularly where the claimant does suffer from co-existing physical conditions.  A Philadelphia long-term disability denial lawyer can review your policy and the facts, and examine whether your claim was wrongfully denied for any reason, including the misapplication of policy limitations or exclusions. 

Let Our Philadelphia Disability Denial Attorney Respond to the Insurer’s Expert Opinions

Your disability insurance company will likely employ experts to evaluate your claim for disability insurance benefits.  Expert opinions may be relied upon to deny or terminate your claim. Your insurance company may utilize a vocational expert to assess the demands of your occupation.  A medical expert could be called upon to provide an opinion regarding the restrictions and limitations caused by your disabling condition and prognosis. However, these experts have not examined you in person.  These experts are often selected by your insurance company, and there may be concerns regarding their credibility and any bias contained in their reviews.

In some cases, an insurance company medical or vocational expert can actually affirm all or part of your claim, though this information may be incorrectly represented in a way that favors the insurer. This is why it is so important to have an experienced disability attorney working with you for disability insurance benefits; your attorney will make sure that favorable information is not minimized or ignored and given due consideration. This process can be agonizing and overwhelming, but we at Seltzer & Associates will be there for you.

You need not experience the pressure of this process unassisted. Your Philadelphia disability denial attorney can address any potential issues concerning insurance company experts and document any objections.

You Should Not Accept A Wrongful Denial or Termination of Your Disability Claim 

Insurance companies commonly deny claims, often unreasonably, which helps to protect their bottom line. This is especially true when it comes to disability insurance claims for well-compensated, skilled professionals such as doctors, surgeons, dentists, and other professionals. Since disability insurance benefits are generally intended to replace income, if a high-income earner is approved for disability insurance benefits, the insurance company may be liable for a significant benefit amount each month. A Philadelphia long-term disability denial lawyer at our firm can evaluate whether your claim has been wrongfully denied and prepare an appeal to help you get any disability insurance benefits for which you are eligible. 

Appealing a long-term disability claim denial or termination is a specific, labor-intensive process.  It is important to understand the procedures set forth in your disability insurance policy, and to meet any strict deadlines set forth. An experienced Philadelphia disability denial attorney can guide you through the disability appeal process, exercise any administrative remedies available to you, and if necessary, file a lawsuit against the disability insurance company. Do not be complacent when it comes to your disability insurance benefits, particularly if your claim is denied or terminated. Let Seltzer & Associates fight for your rights to disability insurance benefits.

Contact a Philadelphia Long-Term Disability Denial Lawyer Today

If you’re unable to work due to illness or injury, dealing with the denial or termination of your long-term disability claim can be flustering. The process is complicated and the reasons for your denial or termination may be insufficient, unclear or plainly wrong. The disability insurance attorneys at Seltzer & Associates can help you understand your policy and your options to get the benefits you are owed. If your disability insurance claim has been denied or terminated, contact us at 888-699-4222 to schedule a free consultation with our legal team. We handle long-term disability claim disputes against all long-term disability companies, nationwide.