Your long-term disability claim may have been denied due to insufficient medical evidence, failure to meet the policy’s definition of “disability,” missed deadlines, or issues with paperwork.
A disability denial can be frustrating, but it does not necessarily mean your claim lacks merit. A nationally recognized Virginia long-term disability lawyer from BenGlassLaw can take on your case and help you appeal the decision.
Why Long-Term Disability Claims Get Denied
Common reasons long-term disability claims get denied include:
- Insufficient medical evidence: Your medical records may not adequately document your symptoms, functional limitations, diagnosis, or inability to work.
- Failure to meet the policy’s definition of disability: The insurer may determine that your condition does not prevent you from performing your job or another occupation covered by your long-term disability insurance policy.
- Preexisting condition exclusions: The policy may limit or exclude coverage for certain medical conditions that existed before your coverage began.
- Missed deadlines: You may have submitted your claim, supporting documentation, or required forms after the applicable deadline expired.
- Inconsistent medical records: The insurer may point to differences between your reported symptoms, examination findings, treatment history, or statements to medical providers.
- Insufficient treatment: The insurance company may argue that you have not pursued appropriate medical care or followed recommended treatment.
- Surveillance or social media activity: The insurer may use photographs, videos, or online posts to argue that your activities contradict your reported limitations.
- Failure to cooperate: You may have missed an examination, failed to provide requested information, or not completed required forms.
- Policy exclusions or coverage issues: The insurer may contend that your condition falls under an exclusion or that your coverage ended before you became disabled.
A long-term disability attorney from BenGlassLaw can review your denial letter and help determine the best course of action.
For a free legal consultation call (703) 591-9829
How Long Do You Have to Appeal a Long-Term Disability Denial?
How long you have to appeal a long-term disability denial depends on the type of plan you have. If your disability coverage comes through an employer-sponsored plan governed by the Employee Retirement Income Security Act (ERISA), federal regulations require the insurance company to give you at least 180 days to submit an administrative appeal.
If you bought an individual disability policy on your own, the deadline to appeal a denial depends on the terms of your specific contract. Some individual policies also allow 180 days, while others have shorter deadlines. A disability claims attorney from BenGlassLaw can help determine how long you have to file an appeal.
How Can a Long-Term Disability Lawyer Help?
If your claim gets denied, a long-term disability lawyer from BenGlassLaw can help by:
- Reviewing your denial letter: A lawyer can identify the insurer’s reasons for denying benefits and determine whether its decision conflicts with your policy or the available evidence.
- Gathering evidence: A lawyer can help obtain medical records, physician statements, and other documentation from Inova Fairfax Hospital or your local doctor that demonstrate how your condition limits your ability to work.
- Preparing an appeal: A lawyer can develop arguments addressing each reason for the denial and organize supporting evidence to strengthen your claim.
- Meeting important deadlines: A lawyer can help make sure you follow the applicable appeal procedures and file your appeal on time.
- Pursuing legal action: If the insurer continues to deny benefits, a lawyer can help you file a lawsuit.
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What Should You Do After a Long-Term Disability Claim Is Denied?
After your long-term disability claim is denied, you should:
- Read the denial letter: Identify every reason the insurer gives for denying benefits, along with any instructions for appealing the decision.
- Request your claim file: Obtain the records the insurer relied on, which may include medical reviews, vocational assessments, surveillance materials, and internal claim notes.
- Keep copies of everything: Save correspondence with adjusters, medical records, claim forms, and proof that you submitted documents on time.
- Get legal help: A disability claims lawyer from BenGlassLaw can analyze your case and assist with your appeal.
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What if My Appeal Gets Denied?
If your appeal gets denied, your options will depend on the type of plan you have. Most ERISA plans only give you one chance to appeal a denial, meaning your only remaining option would be to file a lawsuit in federal district court.
If you live in Fairfax County, you would likely file this type of lawsuit at the Albert V. Bryan United States Courthouse in Alexandria, Virginia. If you purchased an individual disability policy on your own, you may have the right to file a second appeal.
If not, you may be able to file a lawsuit in state court. If you live in Fairfax County, you would likely file at the Fairfax County Circuit Court. A disability denials lawyer from BenGlassLaw can evaluate your case and advise you on next steps.
Long-Term Disability Claim Denials FAQs
Learn more about LTD claim denials by checking out these answers to common questions.
What is the hardest disability to prove?
Some of the hardest disabilities to prove include fibromyalgia, chronic fatigue syndrome, chronic pain, depression, anxiety, and migraines. Any condition that causes subjective symptoms without producing obvious abnormalities on routine medical tests can present challenges.
If you have one of these conditions, you can strengthen your claim by maintaining consistent medical treatment, documenting your symptoms, and asking your healthcare providers to explain how your condition affects your ability to work. A disability denials attorney from BenGlassLaw can help collect medical evidence that proves the severity of your condition.
What are the odds of winning a long-term disability appeal?
Your odds of winning a long-term disability appeal depend on the reason for the denial, the strength of your medical evidence, and the terms of your insurance policy. In general, a denial based on missing documentation is easier to address than a dispute over whether your condition meets your policy’s definition of disability.
While no outcome is guaranteed, a lawyer from BenGlassLaw can improve your chances by gathering additional evidence or demonstrating how your insurer misinterpreted your policy.
How many times can you appeal a long-term disability claim?
The number of times you can appeal a long-term disability denial depends on your insurance policy and the rules governing your claim. Most ERISA plans allow for one required administrative appeal, while private plans typically allow for one or two.
Once you exhaust your internal appeals and your insurer issues a final denial, your only remaining option is to file a lawsuit in court.
Talk to a Long-Term Disability Attorney
Finding out that your long-term disability claim was denied can be distressing, especially if you are unable to work. A long-term disability attorney from BenGlassLaw can read your denial letter, gather additional evidence for your claim, and help you pursue an appeal.
Schedule a free case evaluation to find out how you can secure the benefits you are entitled to.
Call (703) 591-9829 or complete a Free Case Evaluation form