If you have been denied long-term disability insurance, there are a few things you should know. The first is that the company will not tell you why they denied your application. The second is that you can appeal to an independent panel of doctors and experts who may make a different decision about your case.
Long-term disability insurance is a type of insurance that covers the costs of medical expenses, lost income or death if you become disabled and cannot work. If you qualify for long-term disability, it can help cover your living expenses and provide security in case you are unable to work for an extended period of time.
What is Long-Term Disability Insurance, and how does it work?
Long-term disability (LTD) insurance is bought to provide income in the event that a person is wounded or handicapped and unable to work for an extended period of time.
If a long-term disability policyholder becomes incapacitated as a result of a sickness, injury, or accident, the insurance will typically cover 50 to 60% of the afflicted person’s income during the time he or she is unable to work.
Long-term disability insurance may assist pay people while they recuperate or for the duration of their injury, even if the accident or injury did not occur on the job. Long-term disability insurance has unique benefits over workers’ compensation since it covers accidents that occur outside of the workplace.
Read more: 9/11 Survivors’ PTSD Disability Benefits Allegedly Denied by Unum
What is the Process of Long-Term Disability?
Comparing quotes, filling out the necessary paperwork, taking the medical exam, having a phone interview with your potential insurer, going through the underwriting process to evaluate any risks you may provide, and finally receiving approval, the application for long-term disability takes about 4-6 weeks.
After you’ve been accepted, you may buy a disability insurance coverage and start paying monthly payments.
If you are unable to work due to an injury, you will go through the following steps:
- submitting a disability claim and demonstrating your inability to work
- Waiting through the usual 30-day, 60-day, or 90-day first elimination period (but in some cases, these may be longer)
- Receiving your rewards during the duration of the “benefit period”
- Returning to work after you’ve healed and are able to fulfill your regular responsibilities
What is Disability Insurance, and How Does It Work?
What Is the Difference Between Long-Term and Short-Term Disability Insurance?
In order for a handicap to be deemed long-term, the employee must be out of work for at least 2.5 years. Short-term disability insurance provides coverage for three to six months, whereas long-term disability insurance kicks in once that time has passed and may give benefits for years.
A long-term disability insurance may offer coverage for two to 10 years in certain circumstances. In other instances, the insurance will pay benefits until the policyholder reaches retirement age, which is 65 years old. The length of an insurance benefit period is determined by the terms of the policy.
Continue reading: How Long Can You Recieve LTD Benefits?
What is the definition of a Disabling Condition?
Diseases or injuries that restrict someone’s capacity to work are known as disabling ailments. A illness or debilitating condition may sometimes render a person unable to work.
The following is a list of common debilitating conditions for which long-term disability payments may be available:
- Anxiety
- Asthma
- Ataxia
- Auto-immune
- Alzheimer’s
- Disorders of the Back
- Bipolar Disorder is a mental illness that affects people in
- Cancer
- Carpal Tunnel Syndrome
- Cerebral Atrophy is a condition that affects the brain.
- Chronic Fatigue Syndrome
- Chronic Pain is a term used to describe a
- Complex Regional Pain Syndrome (CRPS) is a kind of chronic pain
- Crohn’s disease is a chronic inflammatory bowel disease that affects
- COPD
- Cystic Fibrosis is a disease that affects the lungs.
- Degenerative Disc Disease (DDD) is a kind of degenerative disc
- Dementia
- Depression
- Diabetes
- Epilepsy
- Virus Epstein-Barr
- Disorders of the Eye
- Fibromyalgia
- Headaches/Migraines
- Acute Coronary Syndrome
- Failure of the Heart
- Hepatitis
- Hepatitis C is a virus that infects the liver.
- HIV/AIDS
- Hodgkin’s Disease is a kind of cancer that affects the immune system.
- Insomnia
- Irritable Bowel Syndrome (IBS) is a condition in which the intestines (IBS)
- Kidney Illness
- Knee Problems
- Leukemia
- Lung Cancer is a kind of cancer that affects the
- Lupus
- Lyme disease is a kind of tick-borne illness that
- Macular Degeneration is a condition that affects the eyes.
- Edema of the macula
- Meniere’s Disease is a condition that affects the inner ear.
- Multiple Sclerosis (MS) is a disease that affects (MS)
- Neuropathy
- OCD
- Osteoarthritis
- Paralysis
- Parkinson’s
- PTSD
- Rheumatoid Arthritis (RA) is a kind of arthritis that affects the joints (RA)
- Schizophrenia
- Epilepsy and Seizure Disorders
- Sickle Cell Disease
- Disorders of the Spinal Cord
- Stenosis of the spine
- Stroke
Read more about Can LTD Benefits Be Denied Because of a Pre-Existing Condition?
What is the procedure for obtaining long-term disability insurance?
The majority of companies will provide disability insurance to full-time workers. Some or all of the premiums associated with a disability insurance coverage may be covered by the employer. In the United States, Unum is often the supplier of such insurance.
Employers are obliged to offer at least short-term disability insurance in some jurisdictions, including California, Hawaii, New Jersey, New York, and Rhode Island.
If an employee is a member of a professional group, that organization may be able to provide long-term disability insurance. Discounted group pricing may be available to members of a professional organization.
If everything else fails, insurance brokerage firms such as Guardian, MassMutual, Northwestern Mutual, and Principal may offer disability insurance plans without requiring you to work. Individuals like independent contractors who may not be qualified for long-term disability insurance via their employer may find this alternative appealing.
What Are the Benefits of Disability Insurance?
After deciding on how to get long-term disability coverage, a person must select the details of their insurance. Higher premiums may be caused by a number of reasons, including the policy’s definition of disability, the duration of the elimination period, an individual’s income, the length of benefits, and other characteristics. Compromising on some of these criteria may help you save money on your yearly premiums, but it may leave you with inadequate coverage.
Other variables may have an impact on premium expenses that are more difficult to manage. Age, health, gender, smoking status, and profession, for example, may all affect the cost of an insurance coverage. A health examination may be required for bigger disability coverage plans before a business agrees to insure a person.
It’s also crucial to think about who would be responsible for paying out a long-term disability insurance coverage. Individuals may wish to seek elsewhere if the business has a poor reputation, such as Unum and accusations of bad faith insurance.
Read more: Aetna vs. Cigna: Which Long-Term Disability Insurance Provider Is Better?
Why was my claim for long-term disability turned down?
A long-term disability claim may be rejected for a variety of reasons. Understanding why your claim was rejected may help you either prepare correctly for a claims submission or know how to handle your long-term disability appeal in the best way possible.
The following are some common reasons why your claim may have been denied:
- There is a lack of medical proof. It’s critical that you get frequent medical attention for your ailment and have a well-written doctor’s note as well as a comprehensive list of your medical documents.
- Not conforming to the definition of disability set out in the insurance policy. Each insurance carrier’s terms will differ, so be sure you read the long-term disability provider’s terms and conditions carefully to verify you’re eligible.
- Your disability is disproved by video surveillance.
- Failure to meet submission deadlines. Keep track of the dates for filing and appealing your claim. You won’t be able to challenge your insurer in court if you miss the standard 180-day appeal period.
Read more about Why Is A Long-Term Disability Claim Denied?
How Do I Appeal a Denial of Long-Term Disability?
Insurance firms have been accused of routinely rejecting legitimate long-term disability insurance claims in order to save money and boost profits.
Policyholders may appeal a denial of a long-term disability insurance claim.
Those with Cigna LTD insurance, for example, may call their case manager to verify the status of their benefits information while filing a claim. Cigna LTD insurance applicants have alternatives if their claim is first rejected.
The rejection letter should explain why the LTD claim was rejected and how to appeal the decision. An LTD policyholder has the right to appeal this rejection, but they must follow the insurance company’s procedure and adhere to all deadlines.
Additionally, individuals appealing a rejection of their LTD claim should ensure that they have gathered as much information as possible to support their claim before filing their appeal. This guarantees that before the record is closed, it has all of the evidence required to substantiate their claim.
When an LTD insurance claim is rejected, the burden of evidence for an appeal is comparable to that of a civil trial. This implies that policyholders must provide a substantial quantity of proof to show that their impairment qualifies them for compensation.
Obtaining competent legal counsel may make a big difference in the appeal’s result.
Read more: How Can You Get Help If Your LTD Insurance Is Denied?
If my claim is denied, do I need to hire an attorney?
Because most insurers are big, powerful corporations, submitting an appeal may be daunting. For policyholders, hiring a counsel may help level the playing field. When lawyers are engaged in the appeal process of an LTD insurance claim rejection, the claim is regarded more seriously, according to legal experts.
Insurance companies don’t always play by the rules, which makes a disability insurance lawyer even more important.
When an attorney gets involved, insurance companies understand that they will be held responsible not just for paying due benefits, but also for any bad faith activities they may have participated in.
What Can a Long-Term Disability Insurance Lawyer Do for You?
An attorney who specializes in long-term disability insurance may assist you in the following ways:
- Assist with the completion of insurance paperwork.
- Assess the value of your insurance claim
- Assist you in comprehending the regulations governing long-term disability insurance.
- Assist you in comprehending your choices
- Examine your medical records
- Suggestions for extra medical tests that may be needed in order to win an appeal
- To your claim, include more medical documents.
- Obtain medical records as well as professional views on your condition.
- Obtain testimony from vocational experts.
- Create proof for your “Residual Functional Capacity,” which is an important part of a disability claim.
- Ascertain that the administrative disability appeal is submitted as soon as possible.
- Make sure your benefits are computed properly.
- Any medical, vocational, or legal problems that are part of your claim should be documented in a legal brief.
- If necessary, file a lawsuit.
You only have 180 days to reply to a long-term disability rejection letter, so don’t wait to fill out the form and seek assistance with the appeal before it’s too late.
Read more: Is It Better To Hire A Hartford Disability Lawyer?
When Can a Lawyer for Long-Term Disability Insurance Help You?
A long-term disability insurance attorney may help at any time, however there are particular phases when an LTD insurance attorney can be most helpful:
- When your claim is rejected AND before you file an appeal (since you can’t include new evidence that wasn’t filed during the initial appeal, making it difficult for even an attorney to assist).
- Before you’ve even submitted your disability benefits application. It will assist increase your chances of being accepted or make it more probable that you will be approved if you can obtain aid with submitting your application from an attorney from the start.
- If you were granted for benefits and subsequently had them revoked, you may be able to get assistance from an attorney. This is common because after individuals are authorized, they are still under scrutiny, and the insurance company may determine that even if they are unable to do their former profession, they may be able to perform another. If the insurance provider determines that you are fit to work in a new sector after the first two years, you may be asked to show that you are still qualified for LTD insurance.
- If you haven’t been formally diagnosed yet, or if you’re still in the process of being diagnosed (as often people get sick with a disease such as fibromyalgia that can be difficult to diagnose).
How Much Does Hiring a Long-Term Disability Insurance Attorney Cost?
Long-term disability insurance lawyers operate on a contingency basis, which means they don’t get paid unless and until you win your case. This implies that contacting a lawyer to defend your case carries minimal risk, particularly if your claim has been unjustly rejected.
If you have a long-term disability insurance policy with one of the firms listed above, have applied for long-term benefits, and got a rejection letter in the mail within the past 180 days, you may be eligible for assistance with your disability insurance appeal.
For further information, fill out the free form on this page.
You are not joining any class action lawsuits by joining this inquiry; rather, you are seeking assistance with your long-term disability insurance claim.
If you are applying for social security disability benefits, the social security disability requirements will be important to you.
Frequently Asked Questions
Who qualifies for long-term disability?
What makes you ineligible for long-term disability insurance?
I am not eligible for long-term disability insurance because my doctor has determined that I have a mental illness, which is the cause of my inability to work.
Can you be denied long-term disability insurance?
Yes, if you are not eligible for long-term disability insurance.
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