When an insurance company denies or terminates long term disability (LTD) benefits, it’s typical for claimants to feel discouraged by the excuses used for rejecting their claims. They may even feel too intimidated to take the matter further, and simply give up. In fact, that’s what insurers hope you’ll do. However we urge you to sidestep this tactic and not forfeit the benefits to which you may very well still be entitled. It’s important to understand that insurance companies commonly use illegitimate reasons to reject LTD claims.
At RamosLaw, we are very well aware that disability claim examiners repeatedly use the same unjustified reasons to deny claims. If this has happened to you, please contact us for a free consultation. We will be happy to evaluate your case at no cost, and then determine whether we can help get your LTD benefits approved or restored.
To better illustrate what we mean, we’ve provided five of the most common excuses used by LTD insurers to deny claims- along with some explanations as to why their arguments may not hold up:
1. Lack of Objective Evidence.
Numerous denial letters state that an LTD claim was rejected due to a lack of objective evidence. However, it’s well-established that objective evidence isn’t always able to be provided. Sensibly, courts have long-recognized that it’s an unreasonable stance to require a claimant to provide objective evidence for ailments like fatigue, pain or mental illness. Indeed, there are many genuine ailments that aren’t outwardly visible but are recognized as disabling conditions by the medical community.
2. Change in you plan’s definition of disability.
Most LTD insurance policies state that benefits are to be paid for a finite period of time, (typically two years) if a claimant can no longer perform the tasks associated with his or her regular employment. Once the predetermined time period is complete, insurers continue to provide coverage only if the claimant cannot work in any occupation. In many instances, this change in the definition of disability is used by insurers to give themselves an easy way out and discontinue benefit payments. In many cases, the insurance company simply doesn’t want to acknowledge that a claimant remains fully disabled.
Surveillance videos are a particularly favorite tactic of insurance companies. We have seen this tactic countless times. Most of the time, the activity shown in the video footage can explained. Moreover, these videos only spotlight a very brief time in a person’s life, and are not demonstrative of whether he or she is capable of working.
4.One of Their Doctors has Decided that You are Not Disabled.
This is a good one. We’ve all seen TV shows or movies in which a corporation brings in a “medical mercenary” to offer his opinion, before riding off into the sunset with a large check in his pocket for services well-rendered. Well, sometimes life does imitate art. The reality is simple. No doctor is better suited to issuing a detailed medical opinion on a patient’s condition than the doctor of that patient him or herself. And certainly not a physician who’s flipped through a file, has given a brief examination, and has a significant financial interest in siding with the insurance company. Through diligent research, sometimes we can show the insurer’s doctor’s bias due to the compensation received in exchange for a beneficial report. We work with your personal physician to build your case, and also uncover inconsistencies or omissions in the report presented by the insurer’s doctor.
5. The Social Security Administration’s disability decision does not apply to your case.
Insurers continually ignore the Social Security Administration’s (SSA) determination when sending out claim rejection letters, even though some courts and insurance regulators have found that this practice is problematic. Insurance companies should be required to consider the findings of the SSA, as the standards that it uses to determine disability are usually much stricter than those required under LTD policies. The consistent failure of insurance carriers to give at least some weight to the SSA’s determinations has allowed us to reverse numerous LTD denials or obtain favorable settlements.
Assistance You Can Rely On We’re here to b provide you with vital information regarding your LTD benefits. At RamosLaw, we handle inquiries from countless people just like you, who may not be fully aware of their rights with regard to appealing a denial of benefits. There is no cost associated with your initial consultation. We also assure you of an impartial assessment on the strength of your claim, and whether you should retain us as your attorneys.