13 Feb I have been denied long-term disability: what can I do now?
If your long-term disability claim has just been denied, you may be feeling lost and unsure what steps you should take next. It is not uncommon for insurance companies to deny long-term disability claims. Sometimes the insurer’s answer has nothing to do with the strength of the employee’s case. As an employee, it may be beneficial to contest the rejection.
Why was the claim denied?
When an insurance company rejects your request, they supply a denial letter that is crucial for review because it includes the reason for their decision. There may be many reasons why an insurance company denies your claim. One of the reasons the insurance company could deny your claim is if they believe the employee offered inadequate medical evidence. An employee may receive this response when their disability cannot be observed, like a mental health issue. It is harder to evaluate in this instance, and the severity may be harder to prove.
Even occasions where there may be sufficient medical documents, the insurance company could simply disagree with the employee’s doctor. The insurance companies also have doctors reviewing the medical documents, and they may come to a different conclusion than your personal doctor.
The insurance company could also conclude that you have not followed your recovery planned by your doctor. If you have been on a short-term plan and not executing your treatments, for example, rehab, they may decline the transition to a long-term plan.
Further, the insurance company could conclude the employee is not disabled to the degree necessary for the coverage. The insurance company evaluates the eligibility for the coverage based on how well the employee may complete their work duties in their current state. They may conclude that the employee can fulfill enough of their responsibilities to continue working.
And lastly, the insurers could have secretively monitored the employee and have evidentiary proof that they are not disabled to the degree necessary for the insurance. This is only relevant to cases where the injury is visible. This would not include most mental impairments, mental health issues, cognitive disabilities etc.
How may the employee respond?
When the insurance company supplies the letter of denial, there will also be an option to appeal their decision. The employee will first respond internally, where they would appeal directly to the insurance company requesting to reconsider their claim. The employee may also respond externally, where a lawyer would assist with suing the insurance company and receiving the conclusion of an impartial judge.
The employee may choose to respond externally only when all avenues of an internal response are exhausted. If the employee chooses to hire a lawyer, they must also first respond directly to the insurance agency before commencing a claim. The employee only has two years to respond and hiring a lawyer to conduct the internal response, and potential external response, would be most efficient. The lawyer will know how to follow the process accurately and can easily transition to commencing a claim if necessary.