faq for disability insurance denial

FAQs For Disability Insurance Denial

New Jersey & New York Injury Attorneys

If you have a long-lasting or permanent injury and require long-term disability (LTD) insurance, you may be looking forward to gaining compensation for the injuries you have sustained from an accident. However, the truth of the matter is that many of these claims for benefits are initially denied. This doesn’t mean that you should give up hope. No, in fact, many claims will be turned down at first and this doesn’t mean that you should stop trying to receive them.

Why Was My Claim Denied?

  • In some cases, there was missing or incomplete paperwork on your behalf. Insurance companies won’t do everything for you, so you have to make sure that everything is filed in order for it to be accepted.
  • Disability claims have time limits in which you must follow. If you file too late, you will end up with a denied claim.
  • Filing a false disability claim is a crime, so make sure all information you have told is correct.
  • A lack of treatment could result in a denied claim. Insurance companies will look to see if you are receiving treatment for your disability, so you must make sure that you follow through with all physical therapy and prescribed treatment.
  • The insurance company’s doctor might disagree with something in your claim, so you may have no other choice than to get a second opinion.

What if My Doctor Has Not Released Me to Return to Work?
Have you received a claim denial even though your doctor didn’t advise you to turn to work yet? The insurance company starts doing a medical investigation the moment that they receive the claim. If a doctor peer reviews the claim, comes back, and says, “There is no reason why this person shouldn’t be working,” then the insurance company will rely upon those doctors to deny the claim. This all happens regardless of what the treating physicians are saying.

How Do You Appeal a Claim Denial?

  • Get a Copy of the Policy: Obtain a copy of the LTD policy plan documents from the HR department or from an insurer. If this doesn’t work, you can request them in writing from the plan administrator at the insurance company, who has to abide by a law known as ERISA.
  • Study the Denial Letter: You should review the denial letter and note why your initial claim was rejected and any other information that you may need for claim approval. Make sure that you take note of any filing deadlines.
  • Consider Hiring a Lawyer: You should probably consider hiring an attorney before you file your initial claim. Try to find an attorney that understands ERISA law.

Should I Ask My Doctor For Written Opinions?
It never hurts to ask! Your treating physicians and specialists may be able to provide the best evidence to make your claim. Their written opinions may include things like work-related limitations caused by the medical condition you have obtained. Opinions made by doctors are critical when you are attempting to convince an insurance company of your disability.

It may be quite difficult or even prove to be impossible to fight a disability insurance denial on your own. An attorney that knows the laws of disability insurance will be able to guide you through the basics of the benefits, how ERISA may apply to your case, and help you determine whether or not you are eligible for Social Security Disability Insurance. You can speak to an attorney that you trust by calling MDL for a consultation. They will be able to answer your questions firsthand!