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Disability Denial Letter Must Use Correct Terminology

Have you recently received a long term disability denial letter? It is important to read it carefully and make sure all the language in the letter is in line with your disability claim. Specifically, the letter should accurately refer to the classification of your job as it was used during the claim process.

A recent case involved a registered nurse whose job was classified as a medium level occupation. This means there is a substantial physical component to the job. For example, heavy lifting and moving, the use of force, and physical exertion are common requirements. The nurse filed a long term disability benefits claim with Life Insurance Company of North America (“LINA”).

The claim file showed LINA used the proper job classification throughout the claim and appeal process. The classification of the occupation is undisputed by the parties. The only dispute among them is whether there is enough proof that the claimant was disabled. That dispute then leads to whether her disability prevents her from working as a registered nurse.

However, in this case, the language in the disability denial letter lead the appeals court to remand the case back to the trial court because the denial letter the claimant received stated that a sedentary duty standard was applied. That means that according to the disability denial letter, LINA applied a sedentary job to evaluate the claim. A sedentary job is a lesser standard than a medium level job.

Therefore, LINA sent a contradictory letter to the claimant which raised some issues with the long term disability claim, leading to the lawsuit. This case is a good example of how important it is to read everything carefully and understand what is being said. If you have received correspondence from your insurance company and do not agree with, or understand, what it says, contact one of the experienced long term disability attorneys at our firm and see how we can help.