Long-Term Disability Lawyers

Suffering a serious medical condition can be a devastating event in a person’s life, especially when it prevents them from working or providing for themselves for an extended period. While healthcare can help mitigate the cost of medical bills and long-term care, long-term disability policies can help address the loss of wages that accompany unemployment.

Unfortunately, however, getting the benefits you’re entitled to isn’t always straightforward, even when you provide a valid reason for your claim. The good news is that with effective legal help, the process for filing a long-term disability claim can be more streamlined and can prevent your claim from being denied. 

What Is Long-Term Disability Insurance?

Long-term disability is an insurance benefit that provides a portion of your previously earned salary. Unlike short-term disability benefits, which can terminate in a few weeks or months, long-term disability benefits can last for several years or even until retirement.

Long-term disability can be provided through several different channels; however, filing a claim typically requires a previously established policy. This may be offered by your employer or through private insurers. 

Regardless of the source, long-term disability policies usually cover about 50% to 70% of your pre-disability earnings and are triggered when you meet your policy’s definition of disability. But the definition can vary; some policies cover you if you can’t perform your current job (own occupation coverage), while others only pay benefits if you’re unable to work in any job you’re reasonably suited for (any occupation coverage).

How to File for Long-Term Disability

Filing for long-term disability benefits can be deceptively complex. While the paperwork may look simple, what you submit can make or break your claim. It’s important to begin the process as soon as you suspect your condition will keep you out of work long-term. 

Delays in filing can result in missed deadlines and, ultimately, denial of benefits. Here is the general process:

Long-Term Disability Eligibility Requirements

Before you can file a long-term disability claim, you’ll need to determine if your medical condition meets the right eligibility requirements. This can be verified by your policy handbook. 

If your policy is offered through your employer, your human resources department may be able to confirm if your condition is covered. Otherwise, may be able to find this information in your insurer’s claimant portal. In general, covered conditions may include:

• Musculoskeletal disorders
• Neurological conditions
• Mental health disorders
• Cardiovascular issues
• Autoimmune diseases
• Cancer
• Diabetes complications
• Amputations
• Recovery from a major surgery

Filing Your Claim

Once you’ve determined that your condition is covered, the next step is to gather any medical documentation that details it and its effect on your ability to work. This may include medical records and bills, prescriptions, and statements made by your doctor. After you’ve collected these, the next step is to submit them to your insurance provider with the completed forms. 

You may also be required to notify your employer if you are under their insurance. From there, you should be contacted in a few weeks by your insurance provider for further steps in the review process. This contact may come in the form of a letter, phone call, or both, and will usually confirm receipt of your claim and let you know if additional information is needed.

During this stage, the insurer may also request more detailed documentation or clarification from your doctor. They may also ask you to undergo an independent medical examination or a functional capacity evaluation to assess your ability to perform work-related tasks. 

However, keep in mind that these evaluations are often conducted by healthcare providers chosen by the insurance company and often result in biased assessments. If at any point you feel that your condition is not being accurately represented, it’s best to contact a long-term disability lawyer for help.

Common Reasons Your Long-Term Disability Claim May Be Denied

It’s unfortunately common for long-term disability claims to be denied, even when they are valid. This doesn’t mean that this decision can’t be reversed, but it does mean that you should be diligent when taking the next steps. Some of the most frequent reasons for denial include:

• Lack of sufficient medical evidence
• Pre-existing conditions
• Missed deadlines
• The definition of disability is not met
• Inconsistencies in your file

If you’ve received a denial letter, you will typically have the option to appeal. Review the reason for denial given in the letter and contact your insurance provider if you have questions. Then, collect any additional medical documentation that might help support your claim and follow the appeals process guidelines given by your insurance provider. 

You will need to start this process as soon as possible, as appeals typically come with short deadlines.

Should You Hire a Lawyer for a Long-Term Disability Claim?

Not all long-term disability claims will require legal help, but many claimants choose to work with a long-term disability lawyer at various stages of the process to avoid their claim being denied. This may include help during the filing process to make sure that they’ve filled out the paperwork correctly and submitted the necessary documents, or during an appeal process.

A long-term disability lawyer will be familiar with the many issues that can come up when filing. But more importantly, they will have an extensive knowledge of the law (including ERISA long-term disability laws) as it relates to insurance and claimant rights. If you receive pushback on your right to benefits, a lawyer will be able to utilize this knowledge and years of experience to advocate on your behalf.

Was Your Long-Term Disability Claim Denied? Contact Pond Lehocky

While you will have the option to appeal your long-term disability denial, doing so can be a long and arduous process without legal representation. It also requires prompt filing by the mandated deadlines, as well as hours of compiling medical documentation and communications by the insurance company involved. And unlike short-term disability claims, losing your right to long-term disability benefits can mean that you’re losing years of income without the ability to make your living through employment.

You don’t have to go through it alone. Pond Lehocky’s long-term disability attorneys have decades of experience in cases where a long-term disability claim has been unfairly denied. Our advocacy and legal support have saved our clients millions of dollars through the reversal of denied claims that may have gone overlooked. Contact us today for a free consultation, and we’ll walk through the process together.