Most often, long-term disability insurance is denied for one reason: the claimant did not provide proof that they were disabled.
Getting approved for Long-Term Disability insurance benefits (LTD) usually depends on one thing: proving your claim to the insurance company’s satisfaction. That’s called providing “proof of claim,” and in some cases it’s a lot harder than it should be.
First, here’s what “proof of claim” is NOT:
- It’s not you explaining to the disability insurance company what your medical condition is
- It’s not your doctor telling the disability insurance company what your diagnosis is
- It’s not your doctor telling the disability insurance company that you need to be off work
Instead, proof of claim is about providing PROOF that what you and your doctors are telling the insurance company is true about why you cannot work. Depending on how long you have been disabled and what your disability insurance policy says, you are either providing proof that you cannot do your own job, or that you cannot do any job that you would be qualified for, even a sedentary job that does not require much physical exertion.
Some disability claims are easy to prove. There’s an x-ray that shows your leg is broken, and a job description that explains you need to be on your feet all day.
That’s probably not you because if it were, you wouldn’t be on the internet googling long-term disability insurance. You would have made a claim, your claim would have been approved, you would be receiving benefits. (Lawyers usually don’t see those cases, because they are straightforward and hard for a disability insurance company to deny).
Instead, you are googling, probably because you or someone you care about has a claim that’s not so easy to prove. Your long-term disability claim has been denied, or you are worried that it will be denied. It can feel like your entire financial future hangs in the balance, and you have to get it right. But if you’re never done this before, like most people, it can be overwhelming just to know where to start. So here are some tips:
The best thing you can do is try to be objective about your claim. Think like the insurance company – assuming they are overworked and underpaid and not evil or out to get you (which is usually, but not always, true) why would they deny your claim? It may be frustrating, but sometimes the answer is pretty clear. It often comes down to these common pitfalls:
- There’s just not a lot of medical evidence for them to review because you just started getting treatment;
- Your doctor doesn’t agree your condition prevents you from working;
- Your disabling condition is hard to see or measure objectively. Instead of a broken leg that shows up on an x-ray, its severe pain, headaches, brain fog, dizziness, fibromyalgia, or something along those lines that may be very, very difficult diagnose, let alone prove in a way the insurance company can’t ignore; or
- Related to that, you may have a condition that “most people” either recover fully from, or are able to work around. Even though the science says that “most people” does not mean “all people,” it can still be very difficult to prove that you are one of the unfortunate few who are so impacted by symptoms that you are unable to keep working while receiving treatment.
If long-term disability insurance is denied because your proof of claim is not strong enough, does that mean your claim has no chance of ever being approved? Not always. Here’s what you need to do to give your claim the best chance possible of being approved:
- Get a supportive doctor. There is just no substitute for this. In order to make a successful claim for disability benefits, you must have at least one doctor who thinks that your condition restricts your activities, and will explain that to the insurance company.
- Make sure the restrictions and limitations that your doctor communicates to the disability insurance company would actually prevent you from doing your job. If your job requires you to lift 20 pounds frequently, and your doctor says you can lift 25 pounds frequently, the disability insurance company will say you can work. If your job is sedentary and your doctor says you can sit for up to 8 hours in a day, the disability insurance company will say you can work. If your doctor supports your claim, it’s important that the form they fill out for the disability insurance company reflects that.
- Make sure the disability insurance company understands what your job is. Talk with your company’s Human Resources department to make sure they have an accurate job description for you. (The disability insurance company is supposed to get your job description from HR. Our favorite job mismatch was for a remote customer service rep. The long term disability insurance denial letter called her job a “Moat Service Representative.” She pointed to out to them that no, she did not work in a castle servicing the moat.)
- Take time to explain to the disability insurance company why you can’t work. Don’t rely on them to figure it out from your medical records. Be as factual and detailed as you can. As an example, instead of writing something like, “can’t work because of pain,” fully explain that you “can’t work because pain in my back and neck is 7-9 on a scale of 10. Pain and numbness radiate into my hands, making it impossible to type for more than 10 minutes at a time. Pain in my back requires me to shift positions every 10-15 minutes, and after about an hour or two of that on a good day, I need to get completely off my feet until the pain subsides. I have good days at most 2-3 times per week. On bad days, I am essentially bed ridden.”
- Here’s the most important thing: your medical records must reflect what you are telling the disability insurance company. Don’t tell them your pain is 7-9 on a scale of 10 if your medical records consistently rate your pain as 4-6 on a scale of 10. If your medical records don’t reflect your actual condition, ask your doctor to write a letter explaining why (maybe your doctor only sees you first thing in the morning, when your symptoms are the most well-controlled).
If your long term disability claim is still denied even though you have provided what should be sufficient proof of your disability, you may need a lawyer to handle your appeal. An experienced long term disability attorney should be able to identify where the problems with your claim are and work with you and your doctors to “connect the dots” for the disability insurance company in a detailed appeal. If your claim remains denied? It's probably time to file a lawsuit.
At BenGlassLaw, we will review any letter from a disability insurance company for free and do our best to answer any questions you have about what to do with it.
If we think we can help with the appeal or lawsuit, we’ll give you a proposal for working with us. All free, no obligation, we’re here to help! To get started, call us at 703-584-7277 or email your letter from the disability insurance company to [email protected] along with your questions, and we’ll take it from there. We’ve got you!
Read of others experience with using BenGlassLaw as their long-term disability lawyer here.