A long-term disability claim can be a difficult procedure to navigate. Here are five pointers we provide to all of our clients to help them stay on track.
Tip 1: Keep detailed records as a first step.
"I'll just accept your word for it," unfortunately, does not exist in the insurance industry. Everything will have to be documented in writing at every stage along the process. It's critical to maintain track of anything related to your long-term disability claim, whether it's doctor's notes, medical evaluations, medical records, or postal communication. Make a file at home or scan everything into a computer to keep everything in one place.
Tip 2: Go over your summary plan description one again (SPD)
You should receive a Summary Plan Description whenever you sign up for long-term disability insurance (SPD). This will contain details on how to file, what to file, and who to contact if you have any issues. Before you file, make sure you understand the terms of your insurance since there may be critical elements that you neglect and end up with a denied long-term disability claim.
Tip 3: Making a claim for long-term disability
When making a claim, it's critical to make sure your application gets to the right place. We recommend submitting the claim through certified mail with a return receipt requested so you can be sure it was received and who it was delivered to. The legislation stipulates those benefits must be paid within a reasonable period once a claim is granted, but it does not set a deadline. With few exceptions, your insurance carrier is required to make a decision within 45 days of submitting a claim.
Unfortunately, the claims are sometimes refused. Insurance companies are attempting to make money, and one of the most common ways they do so is by finding reasons to refuse certain claims. They must offer a thorough explanation of why your claim was refused under the law. They must offer an explanation if their decision contradicts the documented judgment of a medical expert or a previous ruling by the Social Security Administration. They must offer the reasons for the refusal, including specific references to your plan's specifics, as well as an explanation of the appeals procedure.
Tip #4: How to File an Appeal for a Claim That Has Been Denied
Don't worry if your LTC claim is denied. You may always appeal. Use your appeal to present fresh evidence. Don't merely write "I appeal" in a letter. Otherwise, all reasons and grounds for appealing a claim denial would be deemed permanently waived.
You generally have 180 days to appeal a refused claim judgment. Your appeal should address the specific reasons for the decision stated in the refusal letter. The person who examines your appeal must be separate from the person who initially denied your claim. Neither your rejection letter nor any subsequent communication can deny your claim based on fresh facts or logic. You must be given ample time to respond to fresh evidence, such as a new medical professional's opinion.
Tip #5: Get Legal Help
The Employee Retirement Income Security Act of 1974 governs long-term disability benefits (ERISA). This is a difficult area of law that frequently needs the assistance of an expert to help you comprehend how the law may apply to your specific situation. If you want to challenge your denial in court, you should definitely consult an attorney. If you have any queries concerning long-term disability or rejection of long-term disability benefits, please contact your attorney.
Published by Dan Zohar