What are Your Rights in a Long-Term Disability Appeal?

Insurance companies will examine every detail of your long-term disability claim with the intent to find something that justifies a denial. Insurance companies are well-versed in ERISA laws — and they also know that most people who file for long-term disability claims are not experienced and can make mistakes. While your best chance for a favorable decision is to have an attorney on your side, knowing your rights can help too.

Why Reviewing Your Policy is Important

You have the right to review your policy and sometimes there are clauses in policies that can affect your claim. You should be aware of any of these exclusions and conditions noted in your policy:

  • Pre-existing conditions - This is very tricky as insurance companies often interpret clauses to their advantage and find loopholes to deny your claim. It’s best to consult an attorney should there be pre-existing condition clauses in your policy.
  • Mental conditions - While some exceptions may apply, disability benefits for mental and nervous conditions are capped at 24 months.
  • The elimination period - There is a three to six month waiting period before you are entitled to disability benefits even while you are disabled.
  • Duration of benefits - Some policies have clauses in which you may only receive benefits until you are 65.
  • Social Security Disability (SSD) - Your policy may state that you must file for SSD benefits. The insurance company will offset SSD which reduces your long-term disability benefit amount.

When applying for long-term disability, you also have the right to access your medical records and other documents related to your claim.

Choosing Your Doctor

You have the right to choose a doctor that you are comfortable with, however, it’s important to remember that a doctor who is not familiar with long-term disability claims can be detrimental to your case. Keep these three things in mind:

  • Are they well-versed in filling out paperwork?
  • Do they understand the importance of meeting deadlines?
  • Do they agree that you are disabled?

Common Reasons for a Disability Appeal

Insurance companies will put your claim under a magnifying glass and all they need is to find just one reason to deny it. Here are the three most common things insurance companies will look for to deny a claim:

  • Lack of medical documentation/evidence
  • Participating in activities that contradict your disability
  • Pre-existing conditions

Steps to An Appeal

Should your disability claim be denied, it’s best to contact an experienced long-term disability attorney for assistance. A long-term disability attorney understands ERISA laws as well as what insurance companies look for to keep your claim in denial status.

Filing a long-term disability claim on your own will not only be complicated, but stressful too. Our disability attorneys will guide you through the process so you can focus on your health and well-being. Don’t go up against insurance companies alone. Contact Dabdoub Law Firm at (800) 969-0488 today to learn more.

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