What Is Long-Term Disability and When Is It Used?
Long-Term Disability (LTD) is a type of insurance policy offered by some employers and available to individuals. LTD protects an employee from loss of income in the event that he or she is unable to work because of illness, injury or accident. LTD differs from Short Term Disability (STD) in the length of time required to qualify. Typically, STD pays a portion of income for a short period of time (usually between 9 and 52 weeks) while LTD usually kicks in after you’ve exhausted a longer waiting period (usually 3 to 6 months).
According to the Council for Disability Awareness over 1 in 4 of today’s 20 year-olds will become disabled before they retire. Some disabilities caused by accident or workplace injury may place an individual off of work for a few short weeks or months. A severe injury requiring a major surgery or a cancer diagnosis may put someone off for several months or years. Most people cannot maintain without their income. That is where LTD comes in to play; by supporting the injured person until they can get back on their feet.
For Information About Applying for LTD, Follow our Easy 5 Step Guide Here
Common Reasons the Insurance Company Denies Long Term Disability Claims
If you follow the 5 steps for long-term disability benefits and receive a denial, know that it is not uncommon. The most common reasons for a disability insurance company or administrator to deny benefits include:
They Claim You Aren't Actually Disabled
Insurance companies or administrators will claim that the evidence provided does not prove that the individual meets the applicable definition of disability. Every LTD policy includes a specific definition of "Disability." For LTD policies, it is common for this definition to include two distinct parts:
- The claimant must prove they are disabled from performing the duties of his or her "own occupation" or "regular occupation", and
- For a set period of time—such as 24 months—the claimant must prove they are disabled from performing the duties of "any occupation".
They Claim You Weren't Disabled Long Enough
The insurance company may also claim your disability didn't last for the entire "elimination period". The elimination period is a set amount of time (typically 90-180 days) that a claimant must prove to be disabled before they are eligible for benefits.
They Claim Your Mental Illness Isn't Covered
Many policies have limits on the amount of time benefits can be paid for mental health.
They Claim Your Disability Is From a Pre-existing Condition
Why You Need a New Mexico Disability Attorney
If you have filed for LTD and have received a denial, it may be time for you to hire an experienced New Mexico Long Term Disability Attorney.
If your claim has been denied, you will receive a letter from the insurance company or claims adjuster informing you of your appeal rights. It is important to consult with an attorney before filing an appeal on your own. There are stringent deadlines in which to submit an appeal, where to send the appeal and which documentation is needed. If you fail to appeal in a timely manner, your claim for LTD will be forfeited.
The Appeal Process is Critical. An Attorney Can Help
ERISA or Employee Retirement Income Security Act governs most private long-term disability benefits. For LTD claims that fall under ERISA, the appeal process is the only time that an individual has an opportunity to produce evidence to refute the denial. Submitting a handwritten appeal without any supporting medical records or documentation to explain why the denial is wrong, is a devastating mistake.
It is not uncommon for an appeal to be denied. At that point, the only recourse is to file a lawsuit in federal court. When a case is filed in federal court, the court looks at what was submitted with the appeal. If the court finds that the insurance company had insufficient documentation on appeal they often will refuse to look at the new medical evidence and support the appeal findings.
The appeal process is crucial to the success of a disability insurance claim. A skilled attorney at Keller & Keller can thoroughly review your case and submit a persuasive appeal letter to the insurance company or administrator.
Request Your Free Consultation Today
The experienced team of attorneys at Keller & Keller are dedicated to fighting for wrongfully denied long-term disability benefits. With years of experience, Keller & Keller is the New Mexico firm you need on your side. We offer a Zero Fee Guarantee, meaning that you will never pay for a consultation and the only way we are paid is if you receive your disability benefits. Complete the form on this page or call us today to get started with your free, no-obligation consultation.