Long-term disability (LTD) insurance is supposed to provide financial protection for workers when illness or injury makes it impossible for them to work. Unfortunately, many claimants are surprised to find obtaining these benefits can sometimes become a difficult fight.
LTD is often provided through an employer or purchased privately. These policies typically pay a percentage of a worker’s salary—often around 60 percent—if a medical condition prevents them from performing their job. Insurance companies, however, carefully review every claim, and it is not uncommon for benefits to be delayed or denied.
One common reason for denial is that the medical evidence does not prove the person is disabled under the policy’s definition. Many policies initially define disability as the inability to perform one’s “own occupation,” but after a period of time the definition may change to the inability to perform “any occupation.” This shift can make continuing benefits more difficult to obtain.
Another issue involves incomplete medical documentation. Insurance companies rely on detailed medical records, specialist reports, and functional capacity evaluations to determine whether a person can work. If medical records do not clearly explain the severity of a condition, the insurer may argue the claimant is capable of returning to work.
For individuals whose claims are denied, the fight is not necessarily over. Most policies provide a formal appeal process. During this stage, claimants have an opportunity to submit additional medical evidence, physician opinions, and other documentation explaining how their condition limits their ability to work. It is important to act quickly because missing appeal deadlines can be extremely harmful to your case.
Beneficiaries should also remember insurance companies can conduct ongoing reviews after benefits are approved. You should always keep updated medical records and continue any recommended treatments for your injury to maintain eligibility.
While long-term disability insurance is meant to provide security during a difficult time, obtaining and maintaining benefits sometimes requires persistence, careful documentation, and a clear understanding of the policy’s rules. Attorneys who handled long-term-disability claims on a regular basis are the shortest route to a successful claim. If you have an LTD claim, check out our web site at JeffreyFreedman.com or call 1-800-343-8537 for a free case review.
