What Should You Do If Your Long-Term Disability Benefits Claim Is Denied?

Q: I recently filed a claim for long-term disability benefits with my work disability insurer but my benefits were denied.  What should I do?

A: If you have filed a disability claim and have been denied, you should first check to ensure that your benefits were not denied because of missing forms or information. If this is not the case, you need to ensure that the medical records and reports from your doctor confirm why you meet your insurance company’s disability test – being unable to complete the essential duties of your job.  You can ask your doctor to write a letter to your insurance company which states that you meet the “own occupation” test or the “any occupation test”.  The former is where you cannot meet the demand of your own job and the latter is where you cannot meet the demands of any other job to which you are suited.

If you have been denied disability benefits because of a pre-existing condition, you need to review your disability policy to confirm how these conditions are treated. If you have not worked for your employer for more than 12 months, then your insurer can review your pre-existing health to see if there was a pre-existing condition prior to you starting your job.  A denial on a pre-existing condition can be seen as a denial in bad faith for many reasons. 

It is important to remember that there are limitation periods for issuing claims against your insurance company, usually 2 years from the date of the denial.

Whatever the reason is for the denial of your disability benefit claim, it is never straight forward.  A good personal injury lawyer with experience in disability claims can assist you in quickly appealing a denial and obtaining the necessary documentation to have your insurance company reconsider a decision. A lawyer can also assist you in starting a lawsuit against your insurance company within the limitation period.