What Makes a Strong LTD Claim Application?
Posted on Monday, August 15th, 2022 at 9:10 pm
If you have suffered a disabling condition that has kept you from working, you likely have concerns about how you will make ends meet going forward. Whether you have long term disability (LTD) insurance through your employer or bought an LTD policy on your own, you will have to file a claim to apply for long term disability benefits. The process can be complex, and getting your claim approved can be a challenge.
Insurance companies deny the majority of claims for LTD benefits, particularly first-time claims. Most often, a claim is denied because of errors, missed filing deadlines, or because the applicant did not qualify for benefits.
Therefore, it is in your best interests to do all you can to improve your chances that the insurance company will approve your application. Following are some things you want to keep in mind to make your application as strong as possible.
Make Sure You Can Prove You Have a Qualifying Disability
You will have to provide evidence that you have a qualifying disability. Your policy will provide a precise definition of what the insurance company considers a “disability,” and you will need to read the policy carefully and have the insurance agent explain everything to you in detail. You should also have an LTD attorney review the policy with you.
The insurance company will base its decision in part on your doctor’s diagnosis and treatment of your condition, and your physician will have to submit forms and statements that detail their opinion with regard to your disabling condition.
In order to increase your chances of approval, you will need to provide as much evidence as you can to support your claim, and you will need to do so according to the requirements and established deadlines outlined in the policy. You should submit any information that is pertinent to your claim, such as:
- Your medical history
- Your physician’s clinic notes
- Lab results
- Diagnostic reports and medical examination notes
- Imaging scans, such as x-rays and MRIs
- Treatment suggestions and methods
- Patient follow-up reports
- Surgical reports
- Prescribed medications and receipts for prescriptions
Additionally, many private LTD insurance companies will require you to also apply for Social Security Disability Insurance (SSDI), and if your disabling injury or illness was job-related, they might require you to apply for workers’ compensation.
Keep in mind that some insurance companies may require you to visit a doctor in their network in order to consider your application. If their doctor determines you are not disabled, the insurance company will most certainly deny your claim. If they deny your claim and refuse to consider testimony from your own physicians, you may have options for resolving the matter in court. Your attorney can discuss your options with you.
Provide Proof That You Cannot Work
If you are seeking LTD benefits, you must have been a full-time employee, and you must show that your disability has prevented you from working and will keep you from working in the future. Your policy could be an “any occupation” policy, in which case you’ll have to prove that you cannot work in any capacity in any job at all. If you have an “own occupation” policy, you’ll have to prove that you cannot perform your specific job, regardless of whether you might be able to perform a different type of work.
Insurance policies vary in how they define “any” and “own” occupation coverage. You should carefully review your policy and understand your options.
In most cases, your employer could provide the doctor’s off-work slips you gave them and your wage statements that show you were off work, but you should also maintain copies of your pay stubs and bank statements as additional proof. In addition, you will need to submit the following:
- The date of the onset of your disability
- The last date you were able to work
- Why the disability prevents you from performing your duties
- What types of medical treatment you are receiving
- The physician who is certifying your disability
Get an Experienced LTD Lawyers to Help You with Your Claim
LTD insurance companies deny disability claims primarily because of qualification issues and mistakes made by the applicant. Even if you follow their requirements closely when applying for disability benefits, you have numerous documents to gather and information to obtain and submit, and it can take months to receive an approval or a denial.
You need an experienced long term disability attorney who understands the application process and can help you gather and timely submit all the elements you’ll need to increase your chances for approval. For help, you can contact the long term disability attorneys of Abell and Capitan Law at (267) 419-7888 to request a free consultation.