Wonder why many LTD claims are denied? Our Winter Park Long Term Disability denial attorney explains tactics insurers frequently use that can impact your rights to benefits.

When medical conditions impact your health and mobility to the point that you cannot work, your employer-based Long Term Disability (LTD) policy protects your financial security. Your policy can reimburse up to two-thirds of lost income if you cannot work for a year or longer, but claims are commonly denied or delayed. Here are the top tactics our Winter Park LTD denial lawyer sees insurance companies use to deny claims.

Disputing Your Eligibility for Coverage

Insurance companies often challenge whether you are eligible for Long Term Disability coverage under your employer’s policy. They may argue that you were not an active employee when your disability began or that your condition is pre-existing and not covered. This tactic can delay your claim significantly and require additional proof of your eligibility.

Questioning Whether You Have a Covered Condition

Insurers frequently scrutinize whether your medical condition qualifies under the policy terms. They may argue that your illness or injury does not meet the policy’s definition of disability. This tactic is prevalent with conditions that have subjective symptoms, such as chronic pain or mental health disorders.

Downplaying the Severity of Your Condition

Even if the insurer acknowledges that you have a covered condition, they may dispute the severity of your disability. They might argue that your condition is not severe enough to prevent you from performing your job duties. This often involves independent medical exams (IMEs) or reviews by their own medical consultants, who might downplay your symptoms and limitations.

Claiming You Failed to Submit the Required Evidence

Insurance companies often deny claims because you did not submit sufficient evidence to support your disability. They might claim that the medical documentation does not adequately demonstrate your inability to work. Ensuring the claimant completes all paperwork and submits comprehensive medical evidence can help counter this tactic.

Delaying the Claims Process

Delays in the LTD claims process can be another strategy insurers use to avoid paying out benefits. They may repeatedly request additional information, conduct lengthy reviews, or fail to respond promptly to your submissions. These delays can be frustrating and financially taxing, leaving you without the necessary income replacement.

Protecting Your Rights When Dealing with Long Term Disability Insurers Winter Park long term disability denial attorney

As an employer-provided benefit, provisions for administering Long Term Disability benefits are covered under the Employee Retirement Income Security Act (ERISA). 

To protect yourself when dealing with insurers and their representatives, follow these steps:

  • Obtain copies of all Long Term Disability policy documents, which you are entitled to upon request and free of charge under ERISA.
  • Ensure your doctor provides a firm diagnosis of your condition and that it qualifies as a Long Term Disability.
  • Keep copies of all medical records to document your condition and the care you have received.
  • Retain copies of all pay stubs showing lost wages and detailed descriptions of your job duties.

Once you file your claim, promptly respond to any insurer communications. If they delay making a decision or dispute your rights to benefits, contact our Winter Park LTD denial attorney.

Request a Consultation with Our Winter Park Long Term Disability Denial Attorney Today

Employer-provided Long Term Disability benefits are a crucial safeguard for your financial stability if you cannot work. However, insurers often use tactics that result in denied or delayed benefits. 

To protect your rights in a claim or appeal, partner with Herbert M. Hill, P.A. Contact us to request a consultation with our experienced Long Term Disability denial lawyer in Winter Park today. Our skilled legal team will ensure you receive the support you need during this challenging time.