Suffering from a long-term disability (LTD) means you already have enough to deal with. You do not want to add fighting with an insurance company to the list. All too often, insurance companies try to avoid paying for coverage. That could leave you vulnerable both physically and financially.
There are actions you can take to fight for LTD coverage. Most insurance policies allow for one or two levels of appeals, after their claim denial. These appeals go to different departments than your original claim, so these may prove successful. If you are on an employee plan, you have to go through the appeals process before you can take steps toward filing a lawsuit.
Before you appeal
Thoroughly read your denial letter. You want to make sure you understand exactly why the insurance company denied your claim. If the letter states you are missing documentation of your condition, you may want to seek out medical records or perhaps have a doctor complete more tests.
This letter will also detail deadlines for response and any requests for specific paperwork. Make sure you meet all deadlines and provide the documentation requested. You do not want an appeal denied because you missed a deadline. You can also ask for a copy of the claim file from your insurance company. This may help you better understand how to respond.
Provide absolutely everything that supports your claim
If you end up filing a federal lawsuit later, you want to have accumulated all possible evidence in your favor during the appeals process. Employer LTD insurance usually falls under ERISA, or the Employee Retirement Income Security Act. With ERISA, when the insurance company denies all appeals, you cannot introduce any new evidence because the record is closed. That means the only evidence you can introduce in your lawsuit is the evidence you presented while you were appealing to the insurance company.
That is why it is so crucial you provide a thorough and comprehensive defense of your claim. Other than medical records, you may want to contact a doctor who will write an opinion about your diagnosis. You want to find any possible way to document your disability. Some experts even suggest keeping a journal to document how your condition and how it affects your life.
Sometimes contacting an attorney earlier on in the process is beneficial. They can help you accumulate evidence and walk you through the appeals process. Additionally, if you are already dealing with a serious disability, you may not be physically able to provide the rigorous defense you deserve. Asking for help is okay.