Oregon Long Term Disability Insurance Attorneys
Abell and Capitan Law is ready to take your call if you need help filing a long term disability claim or appealing a denial in Oregon. The Employee Retirement Income Security Act (ERISA) protects injured workers who can’t return to their jobs after suffering an injury or illness. We understand the regulations under ERISA and how to ensure our clients receive the benefits they deserve.
Your employer probably has a long term disability policy that they provide to their employees. Whether they make partial monthly payments or pay for the entire premium, you can file a claim for replacement wages. Under an LTD plan, you can recover monthly payments, so you’re able to afford medical treatment and the cost of living.
When you get sick or hurt and can’t perform your regular job-related duties, you need the help of an experienced Oregon long term disability insurance attorney. Abell and Capitan Law has the knowledge and resources to protect your rights and get the insurer to pay the money they owe you. If you want to find out more about our legal services, schedule a free consultation, or call us at (267) 419-7888.
What Is Long Term Disability Insurance?
LTD insurance provides injured and ill workers with monthly payments if they’re unable to maintain employment for an extended period. The benefits cover a percentage of your monthly wages so you can support yourself and your family. Benefit payments may also cover the medical treatment you need.
If your employer is paying for your LTD plan, you have protection under ERISA. One of the laws under ERISA is that insurance carriers must disclose their policy information to injured policyholders upon request. The documentation you receive should also include coverage information and instructions on how to file a claim.
There are exclusions listed on every policy that prohibits you from collecting benefit payments under specific circumstances. An exclusion might be an injury you sustained from a car accident. As an example, if the policy excludes a traumatic brain injury and that’s what you suffered in a car crash, you won’t be eligible for benefits.
What Should I Do If I Can No Longer Work?
When you get hurt or sick, you should notify your employer and request an LTD application. Some employers will provide the necessary paperwork, while others might not. If your employer doesn’t give you the form, you can print one online and submit it to the insurance representative yourself. Under ERISA, you have a right to the insurance company name and contact information, a copy of the policy, and instructions for applying.
Your application will need to include an employee statement with details regarding your injury and medical records. If your physician can write a letter for you, that would be ideal. The letter should state the injury or disease you have and how it prevents you from performing your job.
Consistent, ongoing medical treatment is also essential during the LTD claims process. If there isn’t a history of treatment for your injury or illness, the insurance adjuster will probably deny your claim. Evidence is crucial in any insurance claim. The insurance company will review all of it to determine if you qualify for benefits or not. If they approve your claim, you’ll receive monthly payments based on a portion of your average income.
Medical Conditions That Qualify You for LTD Benefits
Following are some of the conditions that are typically covered by LTD insurance plans:
- Different forms of cancer
- Musculoskeletal disorders
- Digestive tract conditions, such as inflammatory bowel disease
- Respiratory illnesses, such as COPD and asthma
- Kidney disease
- Cardiovascular diseases, such as coronary artery disease
- Neurological disorders, such as multiple sclerosis and Parkinson’s disease
- Hematological disorders
- Immune system disorders, such as HIV/AIDS or lupus
- Vision or hearing loss
- Skin disorders
- Mental health issues, such as depression and anxiety
Follow These Steps for Filing an LTD Claim
Following are the steps you can take to file a long term disability claim following the onset of your disability or illness:
- Request a copy of the LTD policy from your employer and read through it carefully to ensure you understand what it says. You can enlist the help of an Oregon long term disability insurance attorney if the language is confusing. We will make sure your injury is a qualifying disability on the plan.
- Talk to your doctor about the injury you sustained in detail. Tell them all the symptoms you’re experiencing and the specific tasks you’re unable to perform at work. Your doctor will need to write a statement for you to submit to the insurance adjuster. The statement must include the disease or injury you have, what bodily functions it affects, and how it inhibits your ability to do your job.
- Attend every doctor appointment and avoid long gaps in treatment. That includes physical therapy, imaging and laboratory testing, surgery, rehab, and specialty providers. If you absolutely must miss an appointment, be sure to reschedule it promptly.
- Document everything. If you talk to the insurance representative over the phone, follow it up with an email. Write down everything you discuss with the insurance company to refer to it later if you need to or use it as evidence. Make a copy of every form you fill out and submit to the insurer. Insurance companies don’t care about you. They care about making and saving money. Insurance adjusters who act in bad faith will lie about the details of your claim or miscommunicate the benefits you’re entitled to, so you’ll accept a low settlement offer. If you keep documentation of everything, no one will be able to take advantage of you.
- Follow all deadlines during the claims process. There are strict deadlines for filing the claim, submitting records to the insurance company, and appealing denied claims. If you miss any deadlines, you won’t receive LTD benefits
- Hire an Oregon long term disability insurance lawyer from Abell and Capitan Law. Going through legal procedures alone is overwhelming, especially if you have complicated circumstances, such as a chronic medical condition or a treating provider who does not supply paperwork. When you hire us, we can take care of every step on your behalf and ensure no one mistreats you.
What Should I Do if the Insurance Company Denies My Claim?
You’ll need to follow steps to file an appeal if the insurance company denied your claim for long term disability insurance. First, let’s discuss possible reasons for the denial. The most common include the following:
- Definition of disability: Policies may differ slightly with the description they use for a disability. If your policy’s definition doesn’t match the disability you have, you won’t be able to recover benefit payments.
- Errors in procedure: There are steps and deadlines you need to follow to ensure LTD insurance eligibility. If you don’t follow those procedures exactly, your claim will get denied.
- Missing records: You must submit all your medical records to the insurance adjuster. If any are missing, that could lead to a delayed claim or even a denial.
- Inconsistent information: The documentation you send to the insurer must be consistent. If records from one doctor contain different information regarding your disability than another doctor, the insurance company will probably issue a denial.
- Insurance bad faith: Insurance companies act in bad faith when they don’t perform a thorough investigation, delay the claim unnecessarily, deny the claim without reason, or withhold payments the policyholder qualifies for.
Employer-paid long term disability policies follow ERISA laws when it comes to appeals. To appeal the denied claim, you must file an administrative appeal within 180 days from the date on your denial letter. The letter should include the reason the insurance adjuster issued a denial.
Make sure to follow the included instructions for appealing the decision and include information you might have missed from the original claim. For example, if the denial letter states there were missing medical records, include those in the appeal.
When you hire Abell and Capitan Law to help you with your appeal, we will review every document related to your disability and treatment to ensure the adjuster receives everything they need, such as:
- Affidavits from medical experts
- Imaging and laboratory reports
- Surgery, hospital, and physical therapy records
- Physician statements
- Copies of your job description and functional capacity reports
- Affidavits from vocational experts
- Statements from friends and family stating the effect the disability had on your life
If the insurance company denies our appeal, we’ll be able to move forward with a lawsuit and argue our case in court.
Do I Have to Pay for a Consultation?
No. We offer a free initial consultation to all prospective clients. If you’re unsure of your options or have questions about the long term disability insurance claims process, you can meet with us for free. One of our Oregon long term disability insurance attorneys will review the details of your case and advise if you qualify for LTD benefits.
Choose Abell and Capitan Law
Abell and Capitan Law has experience fighting for our clients’ rights to ensure they receive the LTD benefits they deserve. When you hire us, we’ll provide comprehensive legal services you can depend on and trust. We care about our clients and have a legal team that’s available 24/7 to take your call.
When you work with our Oregon long term disability insurance attorneys, you will always be a priority to us. We will work hard to fulfill your goals and help ensure your LTD payments are sufficient for supporting your daily life.
When you’re injured, can’t work, and worried about supporting your family, you can turn to Abell and Capitan Law. Call us at (267) 419-7888 today for a free consultation and find out how we can help you secure your long term disability benefits.