Below are answers to frequently asked questions from many of our clients whose long term disability (LTD) insurance claims were denied.
Do you need specific answers from an experienced disability insurance attorney? Please contact Marc Whitehead to schedule a free consultation.
Q: How much time do I have to appeal a denied claim?
If you have an individual LTD insurance policy, one that you purchased privately, the time in which you must appeal the denial will be specified in the letter of denial sent to you by the insurance company. Most private LTD policies allow you 180 days to appeal the denial—but it is critical that you check the denial letter to be sure.
Unlike private disability insurance, a disability policy provided by your employer is governed by a federal law known as ERISA. All ERISA claims have 180 days in which to appeal a denial. Again, this time limit will be specified in your denial letter. In either type of denied claim, if the appeal deadline is missed, you will not be able to appeal your claim.
Q: The insurance company has denied my appeal. What can I do?
If you have exhausted all of the appeal procedures that are required under your policy, then you may have no other choice but to bring a lawsuit against the insurance provider. A lawsuit may also be in order if the insurer is being flagrantly non-responsive by unreasonably delaying their responses to you and giving you the run-around.
A lawsuit does not necessarily mean that a full-blown trial will ensue. Often filing a lawsuit is enough to end the gridlock and wrong behavior from the insurance company, resulting in claim approval or fair settlement.
Q: If Social Security has approved my claim for disability benefits, how can the insurance company deny my claim?
Although the Social Security Administration (SSA) has found you disabled, approval of disability benefits by the SSA is not binding on commercial insurance companies such as Cigna, Unum, Aetna, MetLife and the rest.
Different definitions of disability, standards of claim evaluation, and eligibility rules exist under your insurance policy, versus the manner in which your Social Security Disability Insurance claim is reviewed and decided. Even so, SSA’s approval of your disability claim is an important piece of evidence in your case.
Q: I have a letter from my doctor saying I am totally disabled. Why did the insurance company deny my claim?
Unfortunately, a letter from your doctor is not binding on the insurance company’s determination. The insurance company decides whether or not you are disabled—in fact, the insurance company will use their own medical personnel to review your medical records.
Your doctor’s opinion is just one factor in the insurance company’s determination of disability, and you must be prepared to provide further medical and vocational evidence in proof and support of your impairment.
Q: How long can I expect to receive LTD benefits?
Most long term disability benefits are typically paid for 24 months, if you are unable to perform your own job. After this 24-month “own occupation” period, you can potentially receive LTD benefits until age 65 if you continue to prove that you are disabled from performing “any occupation.”
Q: What is insurance bad faith?
When an insurance company wrongfully and deliberately denies a legitimate claim, they are acting in bad faith. The law requires that insurance companies have a duty to act in “good faith and fair dealing” toward the policyholder. This includes acting in a timely manner.
If in any way the insurer acts to protect its own interests by actively engaging in conduct that seeks to avoid paying coverage of a valid claim, they are not living up to their contractual agreement with you. In addition to unfair denials of claims, examples of bad faith include lowballing (attempting to underpay) a claim payment, and unreasonably delaying benefits.
Q. Why do I need a lawyer?
The reality is most individuals in good health do not have the understanding of disability insurance laws, nor the skills and resources necessary to fight the insurance company’s tactics and team of lawyers. Someone struggling with a disabling condition rarely has the means, or the fortitude, to go the distance without representation.
Insurance companies know this. They are very efficient at denying claims — they want you to accept the denial or ultimately give up.
A skilled disability attorney knows how to push back and fight the strategies of billion dollar insurance companies. He or she has a deep understanding of the disabling conditions that may afflict a claimant, and the technical issues and strategies involved in making an effective argument.
A good disability lawyer is ready to immediately take over all efforts required for a successful disability appeal.
Q: When should I contact a lawyer if my claim is denied?
Once you receive a letter of denial from your insurance company, you should contact a disability attorney immediately. Most disability policies have deadlines for submitting an appeal.
Our long term disability attorneys will evaluate your claim at no cost or obligation to you. In free consultation with us, you will get the clear and ethical information you need to make the right decision on how to move forward with your claim. But do not delay and miss critical deadlines. The sooner we become involved in dealing with the insurance company, the more time we will have to assemble medical, vocational and other substantive information to support your appeal.
Q: What are possible reasons for the discontinuation of my benefits?
Insurance companies find different reasons to terminate benefits. There are time-limits added for certain conditions, like mental disorders or chronic pain, that will limit how long you are receiving your benefits. Also if you choose to cease treatment, insurance companies feel that is a valid enough reason to terminate benefits.
There are times where engaging in specific activities can cause you to lose your benefits. Insurance companies believe that if you are able to participate in activities that may contradict your disability, it is within their jurisdiction to get rid of your benefits.
Q: How can a lawyer help me with my long term disability case?
A long term disability lawyer can help you by reviewing your claim and advise you with available options. They will assist you in filling out specific forms and make sure you aren’t missing any vital details. Their assistance is necessary if you want to create a compelling case in your favor. Our long term disability lawyers understand that you want to seek justice. They have the tools needed to prop you up and represent you in a court of law.
You can discuss these and any other disability insurance questions with an experienced lawyer by calling us toll free at (800) 562-9830. In most cases, we work on a contingency fee basis. This means that no retainer is required, and there are no fees until we win.
Our Long Term Disability Glossary will also help you understand common disability insurance concepts and terms.