Missouri Long Term Disability Insurance Lawyers
Whether you need help filing a claim or appealing a denial, the Missouri long term disability (LTD) insurance lawyers from Abell and Capitan Law can help you when an injury or illness prevents you from returning to work. We have detailed knowledge of the requirements you must meet for your LTD claim under ERISA law, and we know how to effectively prove to the insurance company that you deserve benefits.
If you carry an LTD insurance policy provided by your employer, you can file a claim for replacement wages if you got hurt or sick from a non-work-related event. The benefits you’re entitled to can supplement your income while you’re unable to perform your regular job duties.
Too often, however, getting the benefits you’re entitled to isn’t so simple. Insurance companies will routinely delay, minimize, or deny the insurance benefits you should receive, and the process of submitting or appealing a claim is not only frustrating, it can impact your ability to pay for your basic needs.
The Missouri long term disability insurance lawyers at Abell and Capitan Law will ensure your rights are protected. We know LTD law – it’s all we do – and we will skillfully handle your claim and appeal your denial so that you receive the benefits you’re owed.
Contact our experienced attorneys today. We will review the details of your case, determine your eligibility for benefits, and fight for the benefits you need and deserve. Call us at (267) 419-7888 to schedule your free consultation and learn more about your rights.
How LTD Insurance Benefits Work
Long term disability insurance provides payments to an injured or ill worker who can’t work for an extended period or permanently. You can use health insurance to cover your medical bills, but you’ll need something to cover your lost income. That’s where an LTD policy comes into play.
The benefits you’re eligible to receive depends on the terms listed on your policy. If your employer purchased a plan, you have some protection under ERISA. The Employee Retirement Income Security Act is a law that requires companies to disclose policy information to workers, including information on how to file a claim.
Every LTD policy has specific requirements you must meet to qualify for benefit payments. Some exclusions would prohibit you from collecting, such as if you sustained a particular injury or had a preexisting condition.
When you suffer an injury or illness, you need to notify your employer and request an application to submit. You and your employer will have to fill out different sections of the application and submit it to the insurance company. Along with the form, you’ll also need to provide an employee statement that includes your personal information and details about your injury or illness.
You must seek medical attention immediately so you can use the medical records to prove your disability is keeping you from working. Your doctor will write a letter that you can send to the insurance company showing how your injury or illness precludes you from performing the normal functions of your job.
The insurance adjuster will review everything you send and make a determination based on the evidence you provide and the requirements outlined in the LTD policy. If they approve your claim, you’ll start receiving monthly payments at a percentage of your average wages. If they deny your claim, you’ll receive a denial letter stating the reason and instructions on how you can file an appeal if you believe their decision isn’t valid.
Medical Conditions that Qualify for Long Term Disability Insurance
You might be wondering if your injury or illness is eligible for LTD benefits. That depends on your specific policy, but the most common conditions long term disability insurance typically covers include:
- Autoimmune diseases
- Mental disorders
- Cardiovascular disease
- Physical injury
- Respiratory illness
- Brain injury
- Musculoskeletal and connective tissue disorders
One of the major factors for filing a successful claim is medical evidence. You’ll need to receive an actual diagnosis by a medical doctor. Your LTD policy will require an initial diagnosis along with documentation of ongoing treatment. If the insurance adjuster finds any discrepancies in your records, they will most likely deny your claim.
What You Should Do When You’re Filing a Claim
Following are the steps you should take to file and support your claim:
- Request a copy of your policy from your employer. Review it thoroughly to understand the medical conditions that qualify for benefits and what you need to do to file a claim. Pay attention to any exclusions that could result in a denied claim, such as incidents that preclude you from collecting benefits. While your specific injury might entitle you to LTD payments, the actual physical impairment your doctor says you have might prevent you from receiving any benefits.
- Speak to your doctor in detail about your injury or illness and how it’s affecting your ability to perform your work-related duties. During an LTD claim, your doctor will need to write a statement you can submit to the insurance company. In the letter, they will state the type of injury or illness you have, which bodily functions it affects, and why you’re unable to work because of it. Make sure you read through their letter before you send it to the insurance company to ensure they didn’t forget anything. If your doctor doesn’t specifically say you have a disability, your claim will get denied.
- Show up for every appointment. That includes appointments with your physician and with imaging, labs, physical therapy, rehabilitation, and any other necessary medical treatments, including surgery. Try to avoid skipping or rescheduling your appointments. An insurance adjuster will look at that and determine you don’t have a disability if you don’t require consistent treatment.
- Put everything in writing during the claims process. If you speak to the insurance adjuster on the phone about any pertinent information regarding your claim, follow it up with an email, so there’s documentation of your conversation. Make a copy of every form you fill out and evidence you send to the insurance company. You should never take the adjuster at their word. They could easily delay or deny your claim for an unfair reason, but if you have everything in writing, you can use their own words against them to validate your eligibility for LTD benefits.
- Don’t miss any deadlines. There are strict deadlines you must adhere to during the claims process. It’s especially important to pay attention to deadlines if you need to appeal a denied claim. If you miss a deadline, you’ll lose your rights to any benefit payments in the future.
- Hire a Missouri long term disability insurance lawyer to help you. At Abell and Capitan Law, we know how to handle every aspect of LTD claims. We’ll make sure your claim stays on track, and the insurance company doesn’t take advantage of you or mistreat you. To alleviate your stress, we’ll handle the claims process for you, including gathering evidence for your claim and meeting all deadlines. Having an experienced legal team on your side will make it easier to collect the benefits you deserve.
How Do I Handle a Denied Claim?
If you have an employer-provided LTD plan, you’ll have to follow ERISA law and file an administrative appeal for a denied claim. You will only have 180 days from the date of the denial letter to appeal the decision, so you have to move quickly. It may seem like enough time, but you have to send additional evidence along with the appeal, which could take some time to obtain.
When you receive the denial letter, it should include the reason why the insurance company denied your claim and instructions on how to file an appeal. Your Missouri long term disability insurance lawyer from Abell and Capitan Law will review the letter to determine if the reasoning is valid or if you have grounds for an appeal.
We will go over every piece of documentation from the original claim to find anything you might have missed. If the denial is unfounded, we’ll include additional evidence that supports your rights to LTD benefits, such as:
- Hospital records, imaging reports, lab tests, surgery records, physical therapy notes, and letters from physicians
- Statements from family and friends regarding how the disability affected your life
- Medical expert affidavits
- Vocational expert affidavits
- Job description evidence and functional capacity reports
If the insurance company denies your appeal, we can file a lawsuit and argue your case in court. A judge will review all the evidence you sent to the insurance adjuster and determine if you deserve benefits or if they agree with the adjuster’s decision.
What Are Some Reasons Why My Claim Would Get Denied?
Sometimes an adjuster will deny an LTD claim without thoroughly reviewing the evidence presented to them, while others will act in bad faith because they don’t want you to receive the benefits you deserve. However, there are times when a denial is justified, such as when:
- You’re missing medical records
- Your disability fails to meet the definition provided on your policy
- There were procedural errors, such as a missed deadline
- There were discrepancies in your claim
- You had a preexisting medical condition
Your Missouri long term disability insurance lawyer will make sure the insurance company didn’t act in bad faith, and their reasoning for denying your claim is justified. If we find any evidence of bad faith, when we’ll move forward with an aggressive appeal.
Contact Abell and Capitan Law for Help with Your LTD Claim
Abell and Capitan Law will meet with you for a free consultation to discuss your situation and determine if you’re eligible for long term disability insurance benefits. We know the financial struggles you’re facing because of your injury or illness. It’s our goal to ensure the insurance company treats you fairly and doesn’t deny your claim for an unjustified reason.
If you got sick or hurt and can’t return to work, call (267) 419-7888 today, and one of our Missouri long term disability insurance lawyers will provide legal advice and help you apply for the LTD benefits you need.