Long-Term Disability: Common Issues in the Application Process

Filing a long-term disability claim is both an overwhelming and reassuring process. The reassurance comes from the possibility of receiving financial relief during your time of distress; relief that you may have only considered theoretically before the need arose. However, it can also be very overwhelming when you consider the application process.

A long-term disability lawyer can assist you with navigating through the various hoops and loops that come along with this process. Below is an overview of some of the common issues that have created hurdles for many applicants in the past.

Call Ascend Disability today at (855) 445-9787 and let us help you get the benefits you deserve.

Lack of Punctuality With Notification and Supporting Documents

One of the biggest issues encountered during the application process for long-term disability claims revolves around punctuality. Everything related to the application is time-sensitive and requires a consistent level of urgency from the applicant. Insurers require you to provide notice immediately and follow up on all correspondence without delay. Claims are frequently denied simply because of the failure to comply with the specified deadlines.

The Employee Retirement Income Security Act (ERISA) provides an accurate resource and guide to follow that lays out the standards of timely notifications and compliance requirements for all ERISA-government claims for group disability benefits. The policy language for commercial disability coverage essentially mirrors the deadlines and timeframes referenced within that act.

Preexisting Conditions & Other Excluded Disabilities

If the disability for which you are applying is related to, enhanced, or initiated by a preexisting condition, then the chances of your application being approved are slim. Most long-term disability insurance policies will simply not pay benefits for claims related to preexisting conditions. Your long-term disability lawyer will assist you with determining whether your condition would be considered preexisting or not.

For instance, you can likely classify your condition as preexisting if you:

  • Took medication for it in the past
  • Experienced symptoms
  • Went through the diagnostics related to the condition
  • Attempted to get and/or received treatment
  • Consulted with a licensed healthcare professional about the condition

Just having the preexisting condition does not automatically exclude you from consideration – especially if you were actively working at your job before your initial disability. However, it is still important to disclose your preexisting conditions and work with your lawyer to determine if your condition is excluded for other reasons.

Long-Term Disability Benefits

An Independent Medical Examiner Disputes Your Claim

If the insurer has any doubts related to your long-term disability claim or the length of your disability, then they will likely invest in the services of an independent medical examiner. The examiner will conduct an Independent Medical Exam (IME) that will require you to visit a different physician just for examination purposes.

Keep in mind that the usage of the IME is significantly biased primarily because of how much control the insurer will assume from the start of the process. For instance, the insurer will likely select a doctor that they worked with in the past for similar examinations. Your relevant records may or may not be included with the medical file that they forward to the selected physician. The IME may not even be conducted by a physician who specializes in the field of medicine related to your disability.

Having your long-term disability lawyer involved behind the scenes will help to make sure everything is done by the book and that any discrepancies are erased.

Insufficient Claim Documentation

Another issue is when there is a lack of sufficient documentation provided by the claimant. Keep in mind that detailed information and records are required with long-term disability claims – especially if this is your first time going through the process.

Chart notes, prescription paperwork, medical records, objective testing results, and even narrative reports created by your physician all play key roles in the consideration and determination of your claim. You should also consider gathering paperwork related to your earnings, employment history, medical history, and treatment protocol.

As referenced above, the timeliness of your documentation submission will be considered as well during the application process. If the insurer has questions about specific documents, then you need to relay accurate and detailed responses as soon as possible. The last thing that you want is to submit all the documentation that is needed but to miss the mark by not following up with related questions in a timely fashion.

Schedule an Appointment with an Experienced Long-Term Disability Lawyer!

The details of your specific case may seem unique. However, there are thousands of claimants with similar situations who apply for long-term disability benefits each year. The key is to make sure that you have the legal assistance that you need to guide yourself successfully through the application process.

Call Ascend Disability today at (855) 445-9787 to schedule your free consultation. We will help you map out an action plan and answer any other questions you may have about the application process and subsequent steps.

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