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    Insurance Companies and Long-Term Disability Claims

    Insurance Companies and Long-Term Disability Claims

    Dealing with a long-term disability claim can be difficult. Individuals often must fight for the benefits they need while also managing their health. Yet sometimes it seems as though insurance companies are making getting these benefits harder than it needs to be.

    Understanding how insurance companies operate can make a significant difference in getting an LTD claim approved. This article will break down the ins and outs of long-term disability claims, and the role insurance companies play.

    CCK Law will look at:

    • The basics of long-term disability insurance
    • Common insurance companies that offer LTD benefits
    • Reasons insurance companies frequently deny long-term disability claims
    • And more
    Who We Are: Chisholm Chisholm & Kilpatrick is a leading public interest law firm based in Providence, Rhode Island. Since 1999, we’ve been using educational information and vigorous advocacy to support long-term disability claimants across the United States.

    What Is Long-Term Disability Insurance?

    If someone develops a medical condition that prohibits them from working for an extended period of time, they may need to file for long-term disability benefits. These benefits protect a portion of a person’s pre-disability earnings (typically between 60 and 80 percent). The exact amount varies from policy to policy.

    Long-Term Disability (LTD) 101

    However, to receive such benefits, an individual must have a long-term disability insurance policy from an insurance company. There are two ways in which a person may receive this coverage:

    • Purchased directly from the insurance company
    • Through their employer

    If a person buys their policy directly from an insurance company, then it is called an “individual policy” and is usually subject to state law.

    If a person receives their LTD policy through their employer’s benefits program, then it is typically a “group policy” and subject to a federal law known as ERISA.

    When a person wishes to take advantage of these benefits, they must file a claim with their insurer. To qualify, they must prove that their condition meets their policy’s applicable definition of disability, which will either be an “own occupation” or “any occupation” definition.

    Unfortunately, insurance companies that administer long-term disability policies frequently deny claims, often unfairly. Understanding how these companies justify their decisions can be highly beneficial when preparing an LTD claim or appeal.

    What Are Some Common Insurance Companies That Offer LTD Policies?

    Many insurance companies in the United States offer long-term disability coverage. We have prepared information on some of the most common insurers, including:

    The above list is not exhaustive. However, we have found that these particular insurers are among the most likely to deny claims.

    Note: There are other insurance companies—such as Aetna—that once offered LTD benefits but do not anymore. In these situations, a different insurance company will handle a person’s claim, so it is important to inquire who currently administers a policy before beginning research.

    Does an LTD Claimant Have a Right to File an Appeal?

    If an insurance company denies an initial claim, then the claimant has the right to file an administrative appeal. This may seem daunting, but remember it is necessary to rebut the insurer’s specific reasons for denial.

    As CCK Law Partner Leah Small says, “It’s important to focus the appeal on the reasons outlined in [the] denial letter. So, for example, if The Guardian denied your claim because they obtained surveillance and they argue it documents you’re capable of certain levels of activity, you want to provide evidence that refutes their position.”

    Navigating these denials can be challenging. Insurance companies are not easy to deal with, especially if someone is unfamiliar with their “delay and deny” tactics. For more information, read our article about what to do if your insurer denies your initial claim.

    Still hesitant? You do not have to do this alone. CCK Law has gone up against all the big-name insurance companies. Our team knows how these insurers operate and what they expect in a successful claim. We help our clients fight against these insurers by collecting the right evidence and holding these companies accountable for their actions. If necessary, we are prepared to face these companies in court for your benefits.

    What Are Some Reasons Insurance Companies Deny Long-Term Disability Claims?

    There are many reasons why insurers deny LTD claims. Common examples include:

    • Failure to meet the applicable definition of disability (i.e., the definition in the policy)
    • Missed filing deadlines
    • Lack of objective medical evidence supporting the disability
    • Discrepancies between medical records and the claimant’s reported symptoms
    • Results from independent medical exams (IMEs)
    • Surveillance tactics employed by the insurance company contradict the claimant’s disability claims
    • Preexisting condition exclusions

    Failure to Meet the Applicable Definition of Disability

    Insurance companies often deny LTD claims if they believe that the claimant has not adequately proved that their condition disables them under the definition of disability within their policy.

    To justify its decision, insurance companies use:

    • Biased medical reports (e.g., insurance company-appointed doctors),
    • Surveillance tactics,
    • Social media monitoring,
    • And more
    Definition of Disability in Long-Term Disability Policies Explained

    Missing Filing Deadlines

    Insurance policies contain deadlines that claimants must adhere to when filing for benefits. For example, the notice of claim and the proof of claim each have their own specific deadline. Missing a filing deadline can result in a denial of benefits.

    “Unfortunately, this can be very common because claimants may not understand or fully read their policies, and … do not fully understand the deadlines that can apply,” says Leah Small. “[A] lot of these deadlines can be very strict … and this can result in a claim denial.”

    Lack of Objective Evidence

    Insurance companies, like Unum or The Hartford, often deny claims due to a “lack of evidence.” In other words, the insurance company does not believe that the claimant provided them with enough objective evidence to prove the claim. If this is the case, then the appeal is the time to gather more evidence to strengthen the claim.

    “For our clients,” says Mason Waring, managing partner at CCK Law, “we gather the evidence. We work with your doctors. We work with you. We look at the different places where evidence may be to support your claim and get that into the record. It’s really important to get that done during the initial claim and the appeal process.”

    Discrepancies Between Medical Records and Reported Symptoms

    In some cases, an insurance company will deny a claim if it finds a discrepancy exists between a claimant’s medical records and their reported symptoms. Similarly, a discrepancy may arise due to an IME requested by the insurance company that puts into question other medical records or reported symptoms.

    Surveillance Tactics

    Claimants should be prepared in case their insurance companies attempt to employ several surveillance tactics to try to inject doubt into a claim. Some of the tactics they use include social media monitoring and video surveillance.

    These tactics may “show” the claimant doing something they claim they cannot. However, the insurance companies are usually not attempting to be fair. They often will not consider the full context of what they are seeing, only evidence that supports their denial.

    How Do Insurance Company Surveillance Tactics Work in Long-Term Disability?

    Appealing a Denial of Long-Term Disability Benefits

    All claimants have the right to file an administrative appeal with their insurer. This is usually the most critical phase of the claim process. It is often the last time that claimants may submit new or updated evidence.

    If an insurance company like MetLife or Prudential denies a claimant’s appeal (and ERISA governs the claim), then the evidence submitted during the initial claim and appeal will usually be the only evidence used in court if they choose to file a lawsuit. No new evidence may be introduced at that stage.

    Frequently Asked Questions

    Why do insurance companies deny long-term disability claims?

    Insurance companies often deny claims to limit payouts. Common reasons include a lack of sufficient medical evidence, missed deadlines, or disagreements over whether you meet the insurance policy’s definition of disability.

    How do insurance companies investigate disability claims?

    Insurers may review your medical records, request independent medical exams, interview you, or even conduct surveillance. These methods are meant to verify your condition, but they can also be used to challenge the severity of your disability.

    What should I do if my long-term disability claim is denied?

    You typically have the right to appeal. It’s important to gather additional medical records, expert opinions, and other evidence to strengthen your case. Deadlines for appeals are strict, so acting quickly is critical.

    Can I deal directly with the insurance company, or should I get help?

    While you can deal with the insurer on your own, many claimants find the process overwhelming. Insurance companies have teams of professionals reviewing your file, so having legal help can level the playing field and increase your chances of approval.

    Need Help? Call CCK Law

    Dealing with insurance companies is difficult, but it isn’t something you must handle on your own.

    CCK Law has:

    • Over 25 years of experience
    • Helped claimants at all stages of the process—claims, appeals, and litigation
    • Fought against all major insurance companies in the United States

    Contact Us

    • Call (800) 544-9144 for a free case evaluation
    • Fill out an online form
    • Our team will review your case and determine how we can help.