Long Term Disability Insurance Lawyers Serving Mississippi Residents
Our long term disability insurance lawyers assist disabled individuals in filing for LTD benefits and appealing denied claims in Mississippi. If you suffered an injury or illness outside of work, you might be eligible for benefits through your employer’s LTD policy.
Employers purchase long term disability policies to cover workers that can’t return to their job for an extended period because of an injury or illness. LTD insurance will provide monthly benefits that cover a percentage of the average wages you were earning prior to your disability.
Abell and Capitan Law knows how significant these benefits are to you. If you can’t work and earn a living, you won’t be able to pay for your medical treatment and support your family. It can cause severe financial strain and a mountain of stress. Unfortunately, however, insurance companies will often offer benefits that are lower than what you should be receiving, or they’ll deny the benefits that you deserve.
Our experienced attorneys will work hard to ensure you receive the full LTD benefits you need so you can treat your injury or illness and afford your doctor bills and daily expenses. Call Abell and Capitan Law today at (267) 419-7888. We’ll skillfully handle your claim so that you can focus on your recovery.
What Is Long Term Disability Insurance?
Long term disability (LTD) insurance is a policy that covers a portion of an injured individual’s wages if they become injured or sick and can’t return to their previous place of employment. Many states require employers to provide LTD benefits to their employees, but Mississippi isn’t one of them.
Employers that choose to purchase long term disability insurance for their employees will pay a monthly premium towards the policy. If you suffer an injury or illness outside of work, you can file a claim to receive LTD benefit payments.
If your employer doesn’t carry LTD insurance, you can apply for your own individual plan. You would have to pay a monthly premium that depends on the coverage available on the policy. If you get hurt or sick, you’ll be able to apply for benefits based on the type of insurance you purchased.
How Does ERISA Affect My LTD Benefits?
ERISA, Employee Retirement Income Security Act, is a law that protects disabled individuals’ rights to employer-paid benefits. It requires employers to provide their workers with information about the LTD plan, how to apply for benefits, and other relevant information. When you become disabled and can’t return to work, you can file an ERISA claim through your employer’s insurance company or insurer representative.
You must provide evidence that supports your claim and proves your injury or illness is preventing you from performing your job as usual. Some of the documentation the insurance adjuster will require to review your application adequately include:
- Hospital records showing the injury or illness you’re suffering from and when it first occurred
- Letters from your doctor stating you have a disability and can’t complete your job-related duties
- Physical therapy, diagnostic, imaging, and other medical records proving you have an ongoing condition that consistently prevents you from returning to work
- Documentation that your ailment isn’t preexisting (some policies exclude a preexisting injury or illness from LTD benefits)
What Should I Do if I Get Injured or Diagnosed with an Illness?
The steps you take right after an injury or the diagnosis of a disease are crucial. There are strict deadlines to follow, so you need to take immediate action to ensure you receive the LTD benefits you deserve.
- Notify your employer of your injury or illness and request an application to complete.
- Seek medical attention from a qualified physician and continue treatment with them until they release you from care.
- Submit an employee statement, which includes your personal information, employer information, and information regarding your injury or illness.
- Gather evidence to submit to the insurance company along with your application and statement.
- Obtain your employer’s statement, which is usually a section of the application your employer has to complete.
- Get a note from your doctor that explicitly mentions your injury or illness and prevents you from returning to work.
- File your claim with your supporting documentation.
After receiving your application and evidence, the insurance adjuster will review everything to determine if you qualify for LTD benefits. If they approve your request, your benefit payments will be paid monthly to cover a portion of your average wages.
There’s usually a waiting period, which is the amount of time you have to wait before you start collecting benefits. The waiting period is dependent on the policy your employer purchased. Your benefits will last for a certain length of time, such as five years, or until you turn 65 (if your disability prevents you from performing any type of job). The length of time will depend upon your plan and your injury.
If you can return to work at any time, you’ll immediately stop receiving long term disability benefits because you no longer have an injury or illness that prevents you from going back to your previous job or a similar job.
What Should I Do if the Insurance Company Denies My Claim?
If the insurance adjuster denied your claim and you believe you deserve benefits, you can file an appeal. During the appeals process, you’ll need to submit every piece of evidence you can find that proves your disability keeps you from working.
A denied claim will come with a denial letter stating the reason for the denied coverage, instructions on how to appeal the decision, and the deadlines you have to follow. If your employer purchased your LTD policy, it must follow ERISA laws.
You’ll need to file an administrative appeal within 180 days from the date of the denial letter. You can submit additional evidence that supports your claim for long term disability benefits. Proof of disability you can provide to the insurance company for review includes:
- Opinions from your doctors
- Reports from vocational experts
- Medical testing results
- Functional capacity reports
- Job description evidence
- Affidavits from key witnesses and experts
If the insurance adjuster continues to deny your claim, you can file a lawsuit and argue your case in court. The judge will only consider evidence made available to the insurance company, so you must submit everything you’re able to find during the initial claims and denial processes.
Common Reasons Insurance Companies Deny LTD Claims
If you want to file a successful long term disability claim, you need to know why most insurance claims get denied in the first place. Some insurance adjusters will automatically deny a claim without performing an adequate investigation first, while others will act in bad faith. However, there are some reasons for a denial that are entirely valid.
Incomplete or Incorrect Claim Forms
It’s a requirement to submit completed forms during the claim process for long term disability benefits. If you fail to fill one out or write down false or incomplete information, that could result in a denial.
Lack of Relevant Medical Evidence
Your medical records must state you have a disability from a specific injury or illness. If there’s no mention of a medical problem, your claim will get denied. You also need to complete ongoing treatment until your doctor releases you from their care.
Failure to Attend an IME Appointment
An Independent Medical Examination (IME) is an appointment with a physician that some long term disability insurance companies require applicants to attend. The doctor will ask you questions and perform a thorough evaluation of your injury or illness to determine if your claim is valid. If you fail to show up to the appointment, the adjuster will likely deny your claim.
You have a Preexisting Medical Condition
Some LTD policies exclude preexisting conditions from coverage. If your injury or illness occurred within 12 months of your claim application and the plan your employer purchased doesn’t allow preexisting conditions, you’ll receive a denial letter.
Your Disability Doesn’t Match Your Policy’s Definition
Every long term disability insurance policy has its own definition of a disability. If the policy doesn’t include your specific injury or illness, you won’t receive benefits.
The Insurance Carrier’s Doctor Disagrees with Your Doctor
If the doctor performing your IME determines your condition doesn’t prevent you from returning to work, as your own doctor stated, the insurance adjuster will side with the IME doctor and prohibit benefit payments.
Evidence Showing the Disability Didn’t Interfere with Your Life
During the investigation, insurance companies will review every detail of your life. That includes monitoring your social media and conducting video surveillance of your regular activities. If an investigator catches you doing things your disability should prevent you from being able to do, the result will be a denied claim.
Contact Abell and Capitan Law for a Free Consultation
At Abell and Capitan Law, we understand the struggles you face every day. Your disability diminishes your quality of life, and you can’t earn a living. When you’re unable to work for months or years, it’s stressful thinking about how you’re going to pay for your medical bills and put food on the table. We don’t want to add to your financial burden, which is why we offer an initial, free consultation.
One of our long term disability insurance lawyers will be happy to meet with you to discuss your case. We’ll review all the information you provide and determine if you have a solid case to move forward with. We can provide legal advice and let you know the options you have in front of you.
To find out how Abell and Capitan Law can help you apply for LTD benefits or appeal a denied claim in Mississippi, call (267) 419-7888 today to speak with an experienced long term disability insurance lawyer.