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8 Common Mistakes Made In Long Term Disability Benefits Appeals

8 Common Mistakes Made In Long Term Disability Benefits Appeals

Have you been denied your long term disability benefits claim by CIGNA, Prudential, Hartford, Liberty Mutual, or another disability benefits provider? If so, you are not alone; these insurance companies deny a lot of reasonable claims that end up winning on appeal or in court.

The sad and simple truth is, there is little downside for insurance companies denying your disability claim initially, after all, if you cannot show them how they are wrong, they will never have to pay out your benefits. To help you in understanding and hopefully avoiding common mistakes people often make in filing a disability benefits appeals we created this list of 8 common oversights, gaffes, and errors made by claimants denied long term disability benefits.

 

Not Having A Copy of Your Long Term Disability (LTD) Policy to Review and Understand

If your LTD disability benefits are part of an employee benefits plan from your employer, they might fall under regulations set forth a federal law known as ERISA.  ERISA requires certain processes to be followed by the disability benefits provider, including affording you, the claimant, at least one administrative appeal to a denial of benefits.

Many LTD policies are covered under ERISA, and we have an excellent track record of getting those claims straightened out for clients. However, not all policies are covered by ERISA, and even for the policies that are, reading through your disability policy is necessary for establishing a game plan for your appeal.

This step is undoubtedly something you should have done when filing your initial LTD claim.  If you have not, or did not, already read your policy, do so now.  Your policy can be obtained from your HR point of contact if your LTD policy is part of your benefits plan.   Otherwise, you can obtain a copy of your policy from your disability benefits provider.

 

Sending in Your Disability Benefits Appeal Before Reviewing Your Claim File

If your disability benefits claim is denied, you will likely be notified via a short synopsis of your denial and summary of the issues. However, there is more substantial information you truly need access to in order to best pursue your appeal.

Your disability insurer has been putting together a claim file on you since you filed for disability benefits. While evaluating your claim, they have been gathering opinions from doctors, as well as other facts of the case. They used these facts and opinions to decide the merits of your claim.

While it is possible, they denied you for nefarious reasons; it is more likely they are missing or misinterpreting one key piece of evidence that would change their whole perspective. The only way you or your attorney will know is to get a copy of the claim file (C-File) and figure out what needs to be added to your appeal.

 

Being Too Hasty to Fully Appeal Your Long Term Disability Benefits Claim

When you have been denied, you usually have at the very least, some time, to get a great appeal together. You do not have to file your appeal the same day you receive a denial of benefits. In fact, you probably should not file it immediately.

Take a week or two to find a good attorney, read up a bit on LTD claims and denails, and to start getting your C-File and other items together that will be necessary for your LTD appeal.

 

Waiting Too Long to Appeal Your Long Term Disability Benefits Claim

While, as we alluded in the last common mistake, haste often means waste, procrastination will kill your claim immediately if you miss a deadline to file an appeal. More to this point, even if you do not miss a deadline, if you wait until only a couple of days before the time limit to get your appeal put together, you put future recourse for denials in jeopardy.

The goal of the administrative appeal through your insurer is two-fold. Obviously, the first thing you want to accomplish is overturning the denial. However, if you are looking at the big picture, and hedging your bets, you are using an appeal to add more evidence to your claim file in anticipation that a case may need to be made in court at some point in the future.   If this matter does go to court after your appeals have run out, you will not be able to add new information to the claim that wasn’t already in your LTD claim and appeal the denial in the first place.  This is why it is so important to take your time and get a fully supported appeal together (before your deadline to file).

You can see, waiting until the last minute might move the process forward, but it often does so at the cost of making you less prepared to prevail at future steps.

 

Discounting the Side Effects of Treatment

This mistake and the next one circle back to issues surrounding the information you should be providing vs. the information you are providing to your LTD insurer.

You have an injury or illness that is keeping you from being able to perform the tasks of your previous employment, or potentially all employment. That means you are likely to be receiving treatment or medication, and very possibly both.

Without going into the details of an uncountable number of potential injuries, the idea here is that you should be noting how your treatments impact your health and your life. Perhaps you are sleeping less due to a particular medication necessary to moderate pain?   Alternatively, maybe you may have 2 hours of physical therapy a day, at an opportunity cost of 10+ hours a week and leaves you physically sore and mentally drained?

Whatever the situation is that you find yourself in, you need to look beyond the particular injury in describing your barriers. You should be looking at all the associated challenges this injury has brought into your life, whether they are other injuries (secondary injuries) or side effects to medication, or something else entirely.

 

Not Considering Secondary Effects of Your Injuries or Illness.

Much of the premise for this mistake was covered in the previous example. However, the one point that was not addressed in depth was secondary injuries.

It is very common for an injury so severe that it results in both employment barriers and also in secondary injuries. Consider, how have you been compensating for your reduced abilities? If your back is injured, how are you getting around, crutches? Is this leaving scarring on your arms, stress fractures in your arms? Do you have leg or foot pain or injuries because of how you walk to compensate for your back pain?  These are injuries secondary to your primary impairment, and very much related to your ability to work, and thus your disability benefits claim.

Secondary injuries are still injuries, and they can be just as much of a barrier to employment as your original injury ever was. Your LTD disability insurer needs to understand the full extent of your injuries, work with your attorney to lay this out for them in a way they cannot mistake or reasonably deny.

 

Communicating in Unverified Means – First Class Mail

US Mail is almost 100% efficient, except it seems when it comes to delivering mail for things like disability. To avoid everyone pointing at each other when or if an important piece of mail misses its destination, please send your correspondence to your insurer certified, and copy it to your own files.

Though this falls under “cover your behind” territory, this would not be in our list of common mistakes, if it never happened. Sometimes, the crux of disagreement in a benefits claim comes down to who knew what, when. Having a certified fact pattern of your communications eliminates ambiguity on that front.

 

Not Asking For Help

The last mistake we are covering today is certainly not the least important.

Long Term Disability claim appeals can get complicated, quickly. It certainly is possible that you will be able to overcome a denial to your claim on your own, but doing so on your own and without help will be very difficult. At the very least you should reach out to a couple of people who fight these insurance providers on a daily basis to pick their brains.

We’d be happy to help you get your bearing on your claim, reach out to us by filling out the form at the bottom of this page.  Or by contacting us here.

 

About the Author

In 1998, Chris obtained his law degree from the University of Oregon, and in 1999, he accepted his first job as an attorney with the Washington State Attorney General’s Office. In 2000, Chris entered a private litigation practice in Vancouver, Washington. In private practice, Chris litigated a variety matters including administrative, criminal, real estate, construction, business, and insurance.