Many families prepare for the unexpected by purchasing long term disability insurance. When an insurer denies such a claim, it can leave you and your loved ones struggling to get by. On top of mounting medical bills, you may be without the income you relied on due to a disability. Our Woodlands long term disability lawyer can help.
At Marc Whitehead & Associates, our double-board certified lead attorney, Marc Whitehead, fights for families like yours. Our legal team can appeal a denial of long term disability benefits, whether you have a group claim or an individual claim.
Call us now to learn how our disability lawyers swerving The Woodlands can help. You can schedule your complimentary consultation today.
Why Insurers Deny Legitimate Long Term Disability Claims
Being unable to work due to a disabling condition is difficult enough without then having to battle with an insurance company over your rightful long term disability benefits.
Unfortunately, despite paying premiums, insurers routinely find reasons to deny or terminate valid claims, protecting their profits over your well-being. Some of the most common tactics they use include:
Disputing Severity of Medical Evidence
Insurers may argue that diagnostic tests, clinical findings, and physician statements fail to objectively prove the claimed severity of functional limitations preventing you from working.
Ability to Perform “Any Occupation”
Even if you cannot perform your own job duties, many policies require you to be unable to work any other gainful occupation you may be qualified for based on background, education, and skills.
Alleged Treatment Non-Compliance
Insurers may claim you failed to properly follow prescribed treatment plans or attended medical appointments, using this as justification for denial.
Pre-Existing Condition Exclusions
Disabling conditions that existed prior to the coverage effective date, whether previously diagnosed or not, can be excluded from many long term disability policies.
Favoring Insurer-Paid Examinations
Greater weight may be given to brief evaluations by insurers’ hired medical professionals over the longitudinal treatment relationship with your own doctors.
When residents of The Woodlands have their long term disability claims unduly denied or terminated using tactics like these, having a lawyer helps. We can assist you by collecting definitive proof, appealing wrongful decisions, and suing insurers if necessary to recover essential benefits.
Don’t take on this battle alone against a powerful insurance company. Our Woodlands long term disability attorneys can level the playing field. Reach out to us now.
For a free legal consultation with a long term disability lawyer serving The Woodlands, call 800-562-9830
ERISA vs. Individual Long Term Disability Claims
When seeking benefits for a disabling condition preventing you from working, the process and legal recourse available depends on whether your long term disability coverage falls under an employer-provided ERISA policy or an individual private insurance plan.
ERISA Long Term Disability Policies
If your disability insurance coverage was obtained through an employer or employee benefits program, it is governed by the federal Employee Retirement Income Security Act (ERISA).
These claims follow a specific administrative process:
- Exhausting internal appeals with the insurance company
- If denied, ability to then file a federal ERISA lawsuit
- Federal court conducts review based solely on administrative claim record
- Limited ability to introduce supplemental evidence beyond that record
Individual Private Disability Insurance
With long term disability policies purchased individually rather than through an employer group plan, the claims process differs substantially:
- Must still complete insurer’s internal appeals first before litigation
- Following denial, lawsuits are filed in state court rather than federal
- Additional evidence and testimony can be submitted at the state court level
- Option to bring “bad faith” claims against insurer misconduct
- Ability to potentially recover additional damages beyond just benefit payments
For residents of The Woodlands dealing with a long term disability denial, having an attorney who understands the nuances of ERISA technical requirements vs state-level bad faith individual disability insurance cases is invaluable.
The Woodlands Long Term Disability Lawyer Near Me 800-562-9830
How a Long Term Disability Lawyer Strengthens Initial Claims and Appeals
Whether you’re preparing to file an initial long term disability claim or have already received a denial from the insurer, having an experienced lawyer on your side is invaluable for protecting your rights and maximizing your chances of obtaining benefits.
Building an Airtight Initial Claim
Even before any denial, a knowledgeable long term disability attorney can comprehensively strengthen your initial claim from the outset by:
- Ensuring all medical evidence clearly documents your disabling condition’s severity
- Obtaining supportive statements and opinions from treating physicians
- Collecting records/proof conclusively showing you followed the prescribed treatment
- Preemptively addressing any potential insurer arguments for denial
- Properly completing all claims forms and adhering to filing requirements
Appealing Wrongful Denials
If your long term disability claim is denied, your lawyer immediately transitions to forcefully appealing and overturning that decision by:
- Issuing a timely appeals notice and collecting additional supportive evidence
- Refuting point-by-point the insurer’s stated reasons for denial
- Highlighting any violations of policy provisions or bad faith conduct
- For ERISA claims, creating an administrative record for potential federal litigation
- For individual policies, developing a strong case file for state-level bad-faith lawsuits
From dotting every i and crossing every t on initial long term disability applications to challenging unfair denials through all available appeals channels, having legal representation makes all the difference.
Don’t jeopardize your vital disability benefits by attempting these complicated processes alone against insurance companies. Let our Woodlands long term disability team fight to get you approved.
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Let Marc Whitehead & Associates Handle Your Long Term Disability Claim in The Woodlands
If you are about to file a claim for Long Term Disability, you will want to make sure to submit a compelling application. If you received a denial of benefits, you still have options to fight for them. Our long term disability claim lawyers in The Woodlands can help you in either situation.
Call Marc Whitehead & Associates for help. We can discuss your case in a free consultation.
Call or text 800-562-9830 or complete a Free Case Evaluation form