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What To Do If You Are Denied Your Long Term Disability Insurance Benefits

Wednesday, December 21st, 2022

We are a national disability insurance law firm and have helped thousands of people just like you whose claims for short and long-term disability benefits were denied, terminated, or delayed. We are celebrating our 20th anniversary in 2023, and we know our practice succeeds because of our team’s dogged determination in our representation of our clients.

At the end of the year, insurance companies often hurry to deny or terminate claims so as to improve the corporate balance sheets for the year.  Claim personnel are often pressured to meet year end “targets”. If you have received a claim denial or termination in the last few weeks, you are among many people who are being denied their benefits solely because of the fiscal calendar. But you don’t have to accept this—you can fight back.

If you have been denied short or long term disability insurance benefits, there are a few steps you need to take, immediately. Whether the disability insurance is from your employer or a private policy you purchased on your own, there are strict time limits to appeal the denial.

If you don’t respond in a timely manner, you could lose the legal right to appeal your denial permanently.

To begin, locate the original copy of your disability insurance policy (or secure the policy from your employer if a group plan), and do the best you can to determine the critical dates for when your appeal is due. Every policy is different, so don’t get your information from the insurance company’s website. Even your insurance agent may not have the same information as is contained within your policy.

You need  to review your disability insurance policy and we recommend you have it reviewed by an experienced disability insurance attorney. The policy is a legal contract, and even attorneys have trouble with disability insurance policies. They are convoluted, open to misinterpretation or multiple interpretations, and often skewed in the insurance company’s favor. The case law and court decisions in disability insurance law are complex, and are not consistent throughout the country.

Resubmitting documents to rebut a denial requires a strategic and methodical approach, as the appeal must be bolstered with as much information as possible to withstand challenges both in the administrative appeal and, if it becomes necessary, litigation in federal court.

The obstacles to overcoming a denial are not easy. Here are a few to consider:

Most treating physicians don’t have the “disability insurance claim” experience to prepare medical records to withstand the challenges of a disability claim denial. It’s not their job, nor should it be. However, your medical records are critical to the success of your appeal. They have to do far more than document your illness. They have to define the specific tasks of your occupation and provide evidence of how your illness has impacted your ability to perform the tasks and duties of your occupation.

Medical records aren’t the only critical point in materials submitted for a denied or terminated disability  insurance claim. We have represented and litigated cases over vocational evaluations, when insurance companies like Hartford, Unum and Guardian have used occupational descriptions from databases more than thirty years old. In one case, a senior sales executive whose responsibilities required travelling 60% of the time was refused disability benefits because, according to the insurance company, he had a desk job.  Do not allow your claim to follow this path.

It’s important to recognize that an appeal is a complex legal battle. The disability insurance company prefers that you go to their website and click on a few boxes and upload documents, and submit a one page “I disagree” appeal. This would be a mistake, especially when you are already struggling with an illness or injury. If you miss an important document or if your doctor doesn’t have the correct details in your file, your appeal can be denied. The partners at Frankel & Newfield work with your health care providers and any other professionals to create a robust appeal designed to overcome the insurance company’s challenges.

We recommend calling our office at 877-583-2524 to talk with us and find out how we can help – like we have for nearly twenty years.  Every case is different, every situation is different, but in the twenty years since we founded this law firm, we have represented claimants and we have been successful. There’s no charge for the call, and no obligation.

Jason A. Newfield

Written By:

Jason A. Newfield - Disability Insurance Attorney

Jason Newfield is a founding partner of the disability insurance law firm Frankel & Newfield. He has spent the majority of his legal career advocating for the rights of disabled workers. He has lectured other professionals, worked on a Federal Advisory committee, and published many articles in the field of disability insurance claims and litigation.

Learn more about Jason | See Jason’s Publications

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