Many people are covered by Long Term Disability Insurance (LTD) to protect against the resulting loss of income if they are injured and not able to work. Recently, there has been an increase in the number of denials by the long-term disability insurance companies in response to claims being filed on behalf of the injured insured.
Most employer-proved long-term disability policies are subject to ERISA federal law which stands for the set of federal rules officially known as the Employee Retirement Income Security Act. Many people are familiar with this set of government rules and regulations, as they govern 401K and most other retirement accounts. Due ERISA oversight, if your long-term disability claim is denied, you should hire an attorney who handles these types of claims so that you ensure that the record is preserved in such a fashion that the ERISA requirements are complied with from the minute that your claim is denied. This will ensure that the ERISA appeal process goes smoothly and that all of the evidence that you ultimately wish to rely upon to overturn the initial denial is preserved for the ERISA appeal process and that all ERISA deadlines are complied with.
While the language of each plan is different and my contain other deadlines, most ERISA governed group plans require you to appeal the initial denial within 180 days. This 180 day period is strictly construed, and if you miss this deadline, you right to sue the insurance company will be lost forever. Once again, each plan is different, so it is advisable to hire a long-term disability attorney immediately to review your plan and protect all of your legal rights to receive your payment on your long-term disability insurance claim.
As with other types of insurance claims, long-term disability insurance claims can be denied for many reasons, so of which may be valid and some of which may be illegitimate. The most common reason though, is failure to meet the policy’s definition of disabled. Once again, policy language varies and each policy must be carefully reviewed to determine what the exact definition being used for “disabled” is in the policy. This inquiry would also involve looking at whether the policy is an “own occupation” policy or an “any occupation” policy. Most “any occupation” policies define “disabled” much narrower than “own occupation” policies. In addition, whether for legitimate reasons or not, many initial denials are based on the listed exclusions in a policy, which often-times include disabilities based on substance abuse and pre-existing conditions.
Robert J. Fleming has been handling insurance claim denial cases for individuals and families for over 20 years. He practices in and around the Atlanta, Georgia area including handling lawsuits in Fulton, DeKalb, Clayton, Gwinnett, Cobb and other counties and nearby cities such as Alpharetta, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have recently been denied long-term disability benefits and would like to discuss your case in complete confidence, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.