Denial of Disability and Appeals – Can you do it yourself?
Tuesday, July 30th, 2013
We are a nation of do-it-yourselfers, from putting a new deck in the backyard to fixing the car. But some things, like hanging a 100 pound flat screen television or rebuilding a transmission, are best left to experienced professionals. Appealing a denial of long-term disability (LTD) insurance claim is not a do-it-yourself task. We know this from years of experience as practicing disability insurance attorneys.
Some of our toughest cases, where we have to overcome the problems created by well-intentioned claimants, are the result of our colleagues – attorneys – who consider themselves able to represent themselves in a disability insurance appeal. Even attorneys who practice in the area of insurance are stymied by disability insurance appeals.
Further proof that disability denials are best left to professionals? Our practice has represented a number of insurance sales agents who expected to sail through the application process and, are completely stunned when confronted first with a denied claim and then losing the appeal.
Why is this seemingly simple task so difficult?
Long Term Disability insurance is a complicated financial “product” that is a contract between an individual and a large insurance company. It is written entirely in “insurance-speak” that is a combination of legal and contractual language. There are clauses that appear in some policies that do not appear in others, and while every policy is different, the policies also change over time. An LTD policy that your uncle bought in the 1970s is going to be vastly different than one offered to you at the workplace. A private policy that you bought on your own is going to be different than the one you purchased through a professional association.
Regardless of the difference in types of policies, a few things are the same:
Time limits for filing an appeal are strict and unforgiving.
The medical record must reflect not only the disability, but the specific limitations to the material tasks and duties that the claimant can no longer perform.
The claimant should be under the regular care of a treating physician.
Having a copy of the original disability policy and the summary plan description is far better than relying on your HR department or the insurance company itself to provide you with an accurate copy of your policy. As noted above, these policies change, and you want the original one.