If you suffered an injury or illness that prevents you from working and you previously enrolled in a Long Term Disability plan, you may be expecting your claim to go smoothly. Insurance companies frequently deny such claims for a variety of reasons, though. If you are struggling to access the insurance benefits you paid for, Marc Whitehead & Associates is here to help.
Our Dallas long term disability lawyer can help you submit supplemental documentation. If an insurer still refuses to honor your claim, we can assist you with the appeals process. Our Dallas disability lawyer can even file a lawsuit to seek the benefits you deserve. Call us today to begin learning about your legal options.
How Our Long Term Disability Attorneys in Dallas Can Help
Our long term disability lawyers in Dallas handle two main types of claims: group disability (ERISA) claims and individual disability (non-ERISA) claims. Understanding the difference is crucial for getting the benefits you deserve.
ERISA Claims
Group disability claims involve employer-provided insurance plans governed by the federal Employee Retirement Income Security Act (ERISA). ERISA has strict regulations around filing claims, appeals, deadlines, and litigation. If your group claim is denied, we can guide you through ERISA’s appeals process or file an ERISA lawsuit in federal court on your behalf.
Individual Claims
Individual disability claims stem from private insurance policies you purchase yourself. These are not covered by ERISA, but rather by state laws and insurance regulations. If your individual claim was denied, we assist in overturning that decision. Our lawyers conduct insurer appeals armed with compelling evidence like medical records and employment documents.
If the appeal proves unsuccessful, we negotiate fervently with the insurer to reach a fair settlement, not hesitating to take them to state court if litigation becomes necessary. Regardless of whether your long term disability denial involves an ERISA group plan or a non-ERISA individual policy, our Dallas attorneys are ready to help.
Potential Reasons for Long Term Disability Claim Denials
Long term disability (LTD) claims can be denied for various reasons, some legitimate and others questionable. Insurance companies may refuse to pay benefits in an attempt to protect their profits and minimize costs. Understanding common denial rationales is crucial when fighting for your rightful LTD benefits.
Disputes About the Severity of Your Disability
One frequent reason for denial is the insurance company disputing the severity or validity of the claimed disability.
They may argue that the medical evidence provided does not sufficiently demonstrate an inability to work. Insurers also often claim that the disabling condition is a pre-existing issue and, therefore, is not covered under the policy.
Disputes About How Your Disability Affects Your Work
In other cases, the insurance company may acknowledge the disability itself but contend that the claimant retains the capacity to perform some type of work, even if not in their original occupation. They may hire vocational experts to evaluate the claimant’s transferable skills and argue that alternative employment exists within their limitations.
Clerical Errors
Administrative errors or lack of proper documentation can also lead to LTD claim denials. Insurers may cite missed deadlines, incomplete forms, or failure to follow precise filing procedures as grounds for rejection. Complex policy language can create ambiguities that insurers exploit to their advantage.
Bad-Faith Practices
Sadly, bad faith practices also occur where insurance companies deny valid claims through shady tactics like selectively cherry-picking evidence, misrepresenting policy terms, or simply delaying and stalling until claimants give up.
Regardless of the stated reason, an LTD denial can be devastating. When you hire a long term disability attorney, they can analyze your unique situation and construct a vigorous appeal or lawsuit.
Keep Seeing Your Doctor While Appealing a Denied Long Term Disability Claim
Continuing your medical care during the long term disability (LTD) claim process is important. It supports your overall well-being and strengthens the evidence for your case. Insurance companies often scrutinize medical records meticulously, seeking any potential reason to deny or terminate benefits.
By consistently attending doctor appointments, following prescribed treatments, and adhering to recommended therapies, you create a paper trail substantiating the severity and persistence of your disabling condition. Detailed notes from your healthcare providers, including their objective observations, test results, and expert opinions, serve as invaluable documentation.
Conversely, any gaps or inconsistencies in medical care can raise doubts and provide insurers with ammunition to challenge the validity of your disability. They may argue that your condition has improved or that you are not fully complying with treatment recommendations, potentially undermining your eligibility for benefits.
Call Marc Whitehead & Associates for Help With a Denied Long Term Disability Claim
When you are suffering from a disabling condition, the last thing you need to worry about is the appeals process. At the same time, Long Term Disability benefits can go a long way to help you and your family stay financially afloat in this difficult time. Let our long term disability attorneys in Dallas handle your appeal while you focus on your health.
We are familiar with relevant laws and procedures, enabling us to build and pursue your case with a personalized strategy. Let us put our experience with both ERISA and state insurance claims denials to use for you! We will exhaust every resource possible to get you the benefits you deserve. Contact us today to begin working with our Long Term Disability attorneys.
