After years of contributing to a long-term disability insurance policy, you expect the coverage to kick in when you need it the most. However, this is not usually the case. Insurance companies may deny your claim.
A denied claim does not necessarily mean the end. Depending on the reason for the denial and the terms of your policy, you may be able to challenge the decision through an appeal. Knowing what to do next will help avoid making similar mistakes that could lead to another denial. This article outlines seven common mistakes to avoid after being denied long-term disability.
Ignoring the Denial Letter
Disability policies often establish specific deadlines for filing an appeal. Under federal law, people claiming long-term disability must be given at least 180 days to appeal. When you miss the period, it will be harder to challenge the insurer’s decision. When reading the denial, look for:
- The specific reason your claim was denied
- The evidence the insurer relied on
- Any additional documentation requested
- The deadline for submitting an appeal
- Instructions explaining how to appeal
Accepting the Insurer’s Reasoning Without Reviewing It
Insurance companies make decisions based on the information available to them, and their conclusions are not necessarily the final word. A denial may be based on an incomplete medical record, an unfavorable interpretation of medical evidence, or a disagreement about whether your condition prevents you from performing your job.
An insurer may argue that you can perform your occupation because you can complete certain daily activities. However, being able to take a short walk or perform occasional household tasks does not necessarily mean you can work full-time. Review the insurer’s explanation closely and compare it with your medical records and job requirements. Identifying weaknesses will help determine what evidence should be addressed during an appeal.
Waiting Too Long to Get Professional Help
Trying to handle a denied long-term disability claim alone is not as easy as it may seem. When you don’t understand why your claim was denied or what evidence is needed to challenge the decision, you can easily repeat the same mistakes from the previous claim. Getting help from an experienced lawyer from a firm like Darras Law can be helpful. They can help:
- Review the denial
- Examine the policy
- Identify potential weaknesses in the insurer’s reasoning
- Determine what should be included in an appeal
Failing to Review Your Disability Policy
Your disability insurance policy is one of the most important documents in your claim, yet many people never read it carefully after receiving a denial. This can be a costly mistake. Policies contain detailed definitions that determine whether you qualify for benefits.
For example, a policy may initially require you to be unable to perform your own occupation before later applying a stricter standard involving any occupation for which you may be reasonably qualified. The policy may also contain provisions concerning exclusions, limitations, proof of disability, medical examinations, and appeal procedures. Do not rely only on the insurer’s interpretation of these provisions. Read the applicable sections yourself and determine how the policy defines disability and what it requires from you.
Submitting a Quick or Incomplete Appeal
An appeal is more than a letter explaining that you disagree with the insurer. Simply saying that your condition prevents you from working may not provide enough evidence to overcome the reasons for the denial. A stronger appeal should directly address the insurer’s stated reasons for denying the claim. Depending on your circumstances, supporting evidence may include:
- Updated medical records
- Physician statements
- Diagnostic results
- Treatment notes
- Vocational information
Avoid sending an incomplete appeal just to meet a deadline. Understanding the applicable procedure is important to submit an appropriate response within the required timeframe.
Stopping Medical Treatment
Do not let frustration over the denial interfere with your medical care. Continuing appropriate treatment can benefit both your health and your disability claim. Insurers may review treatment records, and gaps in treatment can raise questions about the severity of a condition.
Continue following your healthcare provider’s recommendations and keep records of:
- Appointments
- Treatments
- Medications
- Testing
- Changes in your symptoms
Providing Information Without Considering Its Impact
After a denial, you may communicate with the insurance company, claims representative, and medical professional. Be careful about what you say and how you describe your condition. Statements that seem harmless can potentially be interpreted out of context.
For instance, saying that you are “having a good day” does not mean you are capable of maintaining full-time employment, but an insurer could potentially use isolated statements when evaluating your functional capacity. The same principle applies to social media. Photos, videos, or posts showing you participating in an activity may not accurately reflect your overall limitations.
Endnote
A denial can be a chance to take a more strategic approach. Avoid making decisions based on assumptions about what the denial means. Go through the terms of your policy, the reason for the denial, and work with a qualified attorney to submit your appeal. They will analyze your situation and explore your options. This way, you can put yourself in a better position to respond effectively to long-term disability.
