The last thing you need when suffering a condition that compromises your ability to work is to have your long term disability (LTD) application denied. The federally enacted Employee Retirement Income Security Act (ERISA) governs employer-provided LTD policies. Pursuant to ERISA, claims administrators, who usually work for your insurance company, evaluate the disability application, which in turn leads to routine denial of claims despite clear evidence of disability. Hiller, PC’s NY disability insurance lawyers understand the reasons for denial and can help you avoid them.
Insufficient Medical Evidence
This includes:
- Regular medical treatment. If you are so disabled that you cannot work, the insurer would expect that you attend regular medical treatments, not only to manage your symptoms, but also to monitor your condition. Whether the treatment is for psychiatric conditions (e.g. depression or anxiety) or physical impairment (e.g. cancer, disease, or injury), you should be treating with your doctors as directed. For physical impairments, you should also be receiving objective tests (e.g. radiological exams, blood tests, urine tests, etc.) whenever possible, which would support your condition and show its progression.
- Missing medical records. Make sure your insurance carrier is requesting appropriate medical records from all your treating physicians.
- Doctor’s statements and opinions. The opinion of your treating physician can be compelling. NY disability insurance lawyers will request your treating physicians to provide a report detailing your medical history, your symptoms, your work-related medical limitations, diagnosis, and prognosis.
- Diary. Some conditions, like depression, chronic fatigue syndrome, fibromyalgia, and chronic headaches and migraines, are subjective in nature; diagnosis is based upon self-reported symptoms rather than objective tests. New York disability attorneys recommend keeping a diary of your symptoms (nature, severity and duration, and how it affected your day), any doctor appointments or urgent care related to your condition, or if you had to miss or leave work early due to your symptoms.
Failure to Meet Your LTD Policy’s Disability Definition
Your LTD policy may define disability as being medically unable to carry out duties of your “own occupation,” which is your particular career. However, disability may be defined more narrowly: you are medically unable to perform duties of “any occupation.” This means if you are a construction worker who cannot lift or climb things, but you can sell products, then you are not disabled. LTD polices may change the disability definition from “own occupation” to “any occupation” after a period of time, usually after 24 months.
Your policy may also have exclusions, such as pre-existing conditions or medical impairments related to substance abuse. Conditions diagnosed based on self-reported symptoms may be limited to 24 months of benefits.
Evidence Contrary to Your Disability Claim
If you are in the process of filing an LTD benefits or are already receiving benefits, your insurer may request investigators to verify the authenticity of your claim. If the investigators uncover evidence of you performing activities inconsistent with your disability, your claim could be denied or benefits terminated.
One way of finding such evidence is social media. For example, if you claim your heart condition prevents you from performing stressful activities, but there are pictures on Facebook, Twitter, or Instagram depicting you skiing, the insurer has a justifiable reason to deny your claim. Investigators may also take video recordings that may justify a denial. The pictures or video records may not actually prove you are not disabled, although they are used to justify a denial. For example, if you have fibromyalgia, you may have “good and bad days,” but the photograph or video recording depicted you on a good day performing light yard work.
NY disability insurance lawyers recommend that you act in accordance with your doctor’s restrictions, even if you are having a particularly good day. If your doctor tells you to walk with a cane, don’t stand for long periods or lift more than five pounds, then don’t shovel the show, play sports, or carry heavy bags from your car.
Missed Deadlines
There are deadlines to filing your claim or appealing a denial. Most individual plans and all group plans governed by ERISA give you 180 days to appeal an initial denial. NY disability insurance lawyers often see claimants miss these deadlines, losing their right to appeal the denial.
Contact NY Disability Insurance Lawyers
Under ERISA, federal courts are only permitted to review an appeal based upon what was submitted to the insurance company. Having knowledgeable New York disability attorneys assisting you from the start will increase your chances of winning your appeal. Not only do our disability lawyers know what materials and evidence insurers are looking for, but also how to package that information in a persuasive application or appeal. Contact NY disability insurance lawyers with Hiller, PC – Attorneys at Law at (212) 319-4000 to get started today!
