Disabled employees who have been issued an LTD insurance claim denial may have a legal claim if they are able to prove that their disability insurance policy unfairly denied their claim.

What is Long Term Disability?

Long term disability insurance
is a kind of insurance policy that protects employees if they should become unable to work because of illness, injury, or accident. These insurance policies provide employees with a financial safety net so that they do not suffer a loss of income if they are unable to work for a significant period of time. Generally, these plans pay out a portion of an employee’s wages while they are unable to work.

While long term disability payments may be crucial for injured employees, many disability applications are rejected by disability claims administrators. Long term disability policies are subject to regulations set in place by a federal law known as the Employee Retirement Income Security Act, or ERISA.

Under this act, disability applications are reviewed and approved or denied by claims administrators that work for the claimant’s own insurance company. Due to this conflict of interest, long term disability applications are often denied despite clear evidence of disability.

What are the Top Reasons for an LTD Insurance Claim Denial?

Administrators may deny long term insurance claims for a variety of legitimate and illegitimate reasons. Some common LTD insurance claim denial reasons include:

• Lack of medical treatment: Patients applying for long term disability payments will be expected to visit their doctors frequently and keep up with all recommended treatments. Patients may need to visit specialists, see psychiatrists or mental health professionals, or allow their doctors to perform objective medical tests.
• Missing or incomplete medical records: Without medical records to back up patient claims of disability, most insurance companies will deny the claim. Patients must ensure that their medical records are up to date and are sent along with their disability application.
• Doctor’s statements: Patients should expect to ask their doctor to provide a detailed opinion regarding their disability and work-related limitations. Without an accurate and thorough doctor’s opinion, many disability claims are likely to be denied.
• Excluded conditions: Checking your individual plan’s definition of disability may be helpful for patients to determine whether they qualify for a long term disability plan. Many plans also include excluded conditions that are not eligible for coverage. These conditions are usually related to substance abuse, and may also include pre-existing conditions. Additionally, conditions that cannot be objectively tested for may not be eligible for coverage, or may only qualify for limited coverage. These conditions may include depression, fibromyalgia, or chronic fatigue syndrome.
• Missed deadlines: It is incredibly important for patients to send in their applications and evidence by the required deadline. Applicants who miss the deadline to apply for benefits may not be able to pursue a long term disability claim.
• Video evidence: In some cases, insurance companies may have investigators follow claims applicants to determine whether their disability is real. Video evidence of patients performing activities that are incompatible with their claimed level of disability may receive an LTD insurance claim denial.

Workers who have been denied long term disability benefits may be able to file a claim against their insurance company if they are able to prove that they were unfairly denied insurance benefits.

Hiring a qualified attorney may be the first step towards pursuing compensation for medical expenses, lost wages, loss of earning capacity, or injuries, pain and suffering.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

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