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My Doctor Says I’m Disabled. Doesn’t the Insurance Company Have to Approve My LTD Claim?

Insurance Company Approve

Not necessarily. Don’t expect an insurance company to simply approve your benefits based on your doctor’s opinion that you are disabled. Generally, to recover long-term disability (LTD) benefits under an employer-sponsored group Employee Retirement Income Security Act (ERISA) plan, or an individual policy that you purchased, you must prove that you are suffering from a covered illness or injury, that you meet your plan’s definition of “disabled,” and that you meet all other applicable criteria for coverage in the plan or policy.

LTD polices, ERISA plans and regulations can be complex, which can make obtaining LTD benefits you deserve a difficult endeavor. Chisholm Chisholm & Kilpatrick LTD helps clients recover the benefits to which they are entitled. Call today for a free consultation: 401-331-6300.

Doesn’t my doctor’s diagnosis and treatment of my medical conditions prove that I am disabled?

Your doctor’s diagnosis alone is probably not enough to persuade an insurance company to pay your benefits. Insurance companies usually require evidence that corroborates that you are suffering from a disabling condition. Treatment can sometimes be good corroborating evidence of disability.

How can I improve the likelihood that my LTD claim gets approved?

While no attorney can guarantee you success, the ERISA attorneys at Chisholm Chisholm & Kilpatrick LTD understand the complexities of ERISA and non-ERISA LTD cases and are able to take on the powerful insurance company for you. Our clients benefit from our knowledge and experience handling ERISA and non-ERISA LTD claims, many on a contingency basis with no upfront cost.

If you have to go it alone, here are some things to consider. Each claim is different so some of these items may not apply to you. This is not an exhaustive list.

  • Know the rules of your LTD plan or policy such as the claim and appeal deadlines, the definition of disability, and coverage exclusions.
  • Know whether your policy requires you to be disabled from your own occupation, or from any occupation. Note that your LTD policy’s definition of disability may be different than the Social Security definition of disability.
  • If you have been denied benefits, closely scrutinize the insurer’s basis for denial against the policy, evidence, and (if applicable) ERISA regulations promulgated by the U.S. Department of Labor. In you appeal, be sure to respond fully to the denial basis with supporting evidence.
  • Collect your relevant medical records that support your claim.
  • Have frank discussions with your treatment providers about your sickness or injury and how it impacts your ability to work.
  • Ask your doctors for reports explaining your impairments and how they prevent you from working.
  • Submit all evidence that supports your claim with your appeal.

The insurance company should decide whether you are disabled based on the evidence and the terms of your policy. Sometimes insurance companies deny benefits even though there is more than sufficient evidence of disability. It is important to have an experienced LTD attorney help you with your appeal.

Call now for a free consultation to see if CCK can assist you: 401-331-6300.