People who enroll in long term disability insurance want to make sure they and their families are covered in case of an emergency. Yet, insurance companies may deny a long term disability claim for a variety of reasons.
You can get help from an Austin long term disability lawyer from Marc Whitehead & Associates if this is the case. Our lead attorney, Marc Whitehead, is double board-certified in disability law and litigation. No matter what kind of denied claim you are facing—an ERISA group claim or an individual claim—we want to get the disability benefits you paid for.
Call us today to begin working with our Austin disability lawyers. We offer free initial consultations.
Common Reasons for Long Term Disability Claim Denials
While dealing with a disabling condition, the last thing you need is to have your long term disability claim unjustly denied by an insurance company. Unfortunately, insurers frequently find ways to avoid paying out on valid claims. Some of the most common reasons they cite for denial include the following.
Lack of Sufficient Medical Evidence
Insurers often claim there is a lack of objective medical evidence proving the severity of your condition and inability to work. They may require exhaustive documentation and test results from multiple treating physicians.
Failure to Follow Prescribed Treatment
If your insurer believes you failed to follow recommended treatment plans or missed medical appointments, they may use this as grounds for denial by arguing your condition is not being properly managed.
Pre-Existing Condition Exclusions
Many policies exclude coverage for disabling conditions that existed prior to the coverage effective date, even if they were unknown or undiagnosed at the time. Insurers rigorously investigate medical histories for any pre-existing issues.
Inability to Perform “Any” Occupation
Some policies require that you cannot only perform the duties of your own occupation but also any other gainful occupation you may be qualified for based on education, training, and experience.
“Self-Reported” Conditions Disputed
For disabling conditions like chronic pain, fatigue, or cognitive impairments that rely heavily on self-reported symptoms, insurance companies frequently try to discredit these as insufficient proof of disability.
With so many potential roadblocks, having the guidance of an Austin long term disability attorney is invaluable for appealing unfair denials and standing up to bad-faith insurance tactics.
For a free legal consultation with a long term disability lawyer serving Austin, call 800-562-9830
Asserting Your Rights Against Denied ERISA and Individual Long Term Disability Claims in Austin
Whether your long term disability coverage falls under an employer-provided ERISA group policy or an individual private plan, insurance companies are notorious for finding loopholes to wrongfully deny or terminate valid claims.
When faced with a denial, having an Austin long term disability lawyer in your corner becomes invaluable for enforcing your rightful benefits.
For ERISA-Governed Group Disability Policies
ERISA (the Employee Retirement Income Security Act) allows federal lawsuits against insurers that improperly deny claims under employer group plans. An attorney can forcefully appeal denials through ERISA’s administrative remedies and file a federal lawsuit if needed. They understand the complexities of ERISA law and can navigate you through an appeal.
For Individual Private Disability Insurance
With individual disability plans, you have additional legal recourses against claim denials. Your long term disability lawyer can file a state-level bad-faith lawsuit asserting the insurer violated contract terms and their commitment to fair claims handling practices.
Resourceful Advocacy Against Insurer Tactics
In either ERISA or private disability cases, our attorneys can work to counter any delay, denial, and termination tactics insurers frequently employ, such as:
- Cherry-picking medical records
- Discrediting self-reported symptoms
- Finding minor non-compliance issues
- Imposing unrealistic demands for objective proof
With meticulous claim support, they refute these bad-faith accusations.
From navigating complex ERISA federal requirements to robustly confronting private insurer bad-faith practices, the right Austin long term disability lawyer ensures no unjustified roadblock prevents you from receiving your vital disability benefits and financial security.
Austin Long Term Disability Lawyer Near Me 800-562-9830
Appealing Denied Claims and Suing for Long Term Disability Benefits
When an insurance company wrongfully denies or terminates your long term disability claim, you have options for forcefully appealing the decision through administrative channels or taking direct legal action. A long term disability lawyer in Austin, TX, can guide you through either path.
Pursuing Administrative Appeals
If your claim is governed under an ERISA employer policy, federal law requires you to first complete the insurer’s internal administrative appeal process before filing a lawsuit. During this appeal phase, your attorney will construct a comprehensive, airtight claim file leaving no legitimate grounds for denial:
- Obtaining comprehensive supportive medical evidence and documentation
- Soliciting statements from treating physicians and vocational experts
- Refuting assertions about sufficient work ability or failure to follow treatment
- Highlighting policy provision violations and bad-faith conduct by the insurer
For private individual disability policies, appealing through an insurer’s internal process is also typically required prior to litigation, following similar evidence-gathering strategies.
Suing Insurers for Benefits and Damages
If appeals are unsuccessful, your long term disability lawyer can then take legal action against the insurance company by filing a lawsuit to recover benefits rightfully owed.
For ERISA claims, they will file a federal lawsuit using the solidified claim record from appeals. The court conducts a review of the administrative record without new evidence. For individual policies, our Austin, TX, long term disability attorney can file a lawsuit in state court.
With the stakes so high, having a dedicated Austin disability lawyer advocating for you, leading your appeal, and litigating against insurer denials can make all the difference.
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Call Marc Whitehead & Associates for Help With a Denied Long Term Disability Claim
You still have options if an insurance company denied your long term disability claim. Our Austin lawyers can fight back against bad-faith insurance tactics and gather supplemental medical evidence for your appeal.
Contact us today to schedule an appointment with our team. We are ready to help you and your family during this uncertain time.
Call or text 800-562-9830 or complete a Free Case Evaluation form