Under most long term disability insurance plans the insurance company has the discretion to interpret plan provisions. What that means is they have the right to review your case to determine whether you have satisfied the definition of disability. The long term disability insurance company does have the right to deny your claim.
The approval rate for initial claims is actually pretty high, but staying “on claim” and continuing to receive LTD benefits is much more difficult. Benefits may be granted at first, but a poorly prepared application for benefits may cause your claim to be terminated in the future.
Harmful Elements on Your Application
Claims are often denied because you did not provide sufficient evidence for approval. This is why it is so important to double-check everything before you submit it. Did you provide the correct doctors’ names and addresses? Did you provide the correct dates of service? The majority of claims are denied due to simple mistakes that can lead to months of frustration for you. Some insurance companies will try to point out “bad facts” that are on your medical record. This could be drug abuse, alcoholism, working after you say your disability started, or a doctor notating that you are exaggerating your claim. If you feel that these bad facts are hurting you, contact the Ortiz Law Firm and let us help you.
Communicating with the Insurance Company
The best way to communicate with the insurance company is in writing, on paper. You should limit the number of communications you have with the insurance company on the phone, for the exact reasons that brought about the topic of the video above. That is, oftentimes the insurance company won’t summarize what you said correctly in their letters to you. If the insurance company is calling you asking you for additional information or questions, we recommend that you ask them to put those questions in writing. Then respond to those questions in writing either in a letter, by fax, or potentially by email.
You should make sure that your letters are consistent with your limitations. So for example, if you have carpal tunnel syndrome and you have difficulty holding on to things, and you write a really long letter in longhand, you should indicate to them how long it took you to write the letter. Or if someone helped you write the letter, tell them that in your letter.
If the insurance company tells you something, and it’s something that’s beneficial to you, you should confirm that in writing. For example, if the insurance company adjuster told you, “We’re not going to be looking at your file for another year. We’re just going to pay you benefits for the next 12 months without further review,” then you should write a letter to the insurance company confirming that communication and saying, “This confirms that we talked and you said you wouldn’t need to review my file for another year.” All to often people do not confirm things in writing when they communicate with the insurance company.
Legal Representation in Long Term Disability Insurance Claims
Although based in Florida, the Ortiz Law Firm represents claimants across the United States. If your LTD claim has been wrongfully denied, delayed or terminated and you’d like to speak to an experienced Long Term Disability Insurance Attorney contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long Term Disability Benefits and how to move forward with the process.