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Has Your Insurance Company Denied
Your Disability Claim?

Whether an insurance company, employer, union or other ERISA governed
plan has denied your insurance claim, we can help.

Red Flags on Your ERISA LTD Application

If you’re unable to work, you may qualify for long-term disability (LTD) benefits under your employer’s Employee Retirement Income Security Act (ERISA) plan. An ERISA LTD plan can provide you with financial security while you cannot work due to a serious medical condition caused by a sickness or injury. Your employer or insurance company should provide you with an application and all necessary information to apply for LTD benefits.

An ERISA LTD application can be complex and may require significant details regarding your medical conditions and your functional restrictions and limitations caused by medical conditions. Although your employer does not have a legal right to details regarding your medical condition, the insurance company that may be providing you with LTD benefits can request certification of your conditions. It is your responsibility to complete all application materials and to provide medical proof of your condition. However, in doing so, there are many issues that can raise red flags that will cause your insurance company to investigate further or request additional information.

When completing the application, avoid these common mistakes:

1. Missing deadlines. Your employer and the insurance company will have deadlines by which you must notify them of your medical condition and submit your application and supporting information. Do not miss those deadlines. Make sure your medical provider knows that you need supporting medical information by a specific date. If you cannot meet a deadline, contact your employer or insurance company and make sure they know the information is on its way. Ask for an extension. Most employers and insurance companies are forgiving when you ask in advance rather than after the deadline expires.

2. Failing to keep copies of documents and medical records. You will submit multiple documents related to your LTD application and supporting medical information. You will also have to obtain medical records and provide copies to your insurance company. You may also have to submit to a disability evaluation by your medical provider or an independent provider. Be proactive. Don’t expect the insurance company to get the records. If you are too ill, injured or overwhelmed, get a family member or friend involved. Keep copies of everything you give to the insurance company and all correspondence you receive from them.

3. Choosing the wrong the last date worked (LDW). Your insurance company will need to know the last day you worked to begin processing your LTD claim. You must have evidence from your employer and your medical provider regarding your LDW. Notify the insurer of your claim, if you can, before you choose not to return to work. Your employer should provide information about when you became unable to perform the essential duties of your job, and your medical provider should offer information about when your condition became so serious that you could not work. Those dates should coincide. If they do not, your insurance company may inquire further and may even deny your claim. Sometimes people who are functionally disabled under their LTD plan keep working. The law recognizes the concept of working while disabled.

4. Only providing documentation on forms provided by the insurance company. Although your insurance company will provide you with forms to document your disability, you should also provide medical records, test results, and any other medical documentation that proves you have a serious medical condition and cannot work. Often the insurance company forms provide little space for you to describe your condition. You’ll need to attach additional sheets to provide an adequate description. The more information you provide, the more likely you are

to be approved for benefits. In general, more information benefits you.

5. Relying on advice from your human resources department. Although your human resources department can help you when applying for LTD benefits, know your rights and responsibilities according to the insurance company. Human resources personnel are not experts on the law or on insurance policies. Legally, your insurance company must tell you your rights and responsibilities. Review what you need to do to meet those responsibilities.

6. Participating in activities that your doctor prohibited. If your doctor gives you restrictions for physical or non-physical activities, you must abide by those restrictions both at work and in your personal life. If you participate in recreational activities that require intense physical exertion and your insurance company discovers those activities on social media or from coworkers, you may be denied benefits. Most physicians will advise you to keep exercising. You only have a problem when you tell your doctor you cannot do an activity and then you do that activity despite having told your doctor you can’t. Sometimes the activity is inconsequential, but insurance companies too frequently will challenge your credibility.

7. Social Media should be set on private viewing only. Insurance companies love hunting on social media. Often social media does not reflect reality but what is posted may harm you. Insurance companies will search for you or retain a business such as Page Vault, to gather information from your social media posting. Don’t destroy your social media. Just limit access to real friends, family and others whom you trust.

8. Failing to seek legal help quickly. If you apply for LTD benefits and are denied, immediately seek the assistance of a disability attorney to represent your pre-suit appeal. The goal of a good ERISA disability attorney is to get the claim reinstated or granted without filing a lawsuit. But if you need to file suit, you must file a well supported appeal pre-suit.  Don’t wait until your next step is federal court. Better yet, involve an attorney before you apply. Your chances of success are dramatically better if you submit a thorough, timely, and professionally prepared application. Making an ERISA LTD application may seem straightforward, but it’s easy to make errors that can cause denial of a deserving claim. The application can be complex, and the medical information needed to prove that you are disabled may be confusing. Our experienced ERISA disability attorneys can help you at every step of the process. We will help you complete an application, file an appeal, or lawsuit as necessary. We can answer any questions about your rights and responsibilities. Call Jonathan M Feigenbaum, Esquire at 617-409-0539 to arrange for your consultation.

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