If you are disabled and can no longer work, you can qualify for your employer-sponsored long-term disability (LTD) policy. However, your odds of receiving the benefits depend on your ERISA application process. The application process can be challenging and complex, and a single error can result in the insurance company denying your claim for benefits. This blog discusses common mistakes to avoid during your long-term disability benefits application.
Avoid Overstating Your Signs and Symptoms and Overstating Your Abilities
Your LTD insurance claim examiner is looking for reasons to deny your application and claim for benefits. Any reason that questions your credibility is enough to deny the claim of benefits. Therefore, you should be honest when reporting your limitations and signs and symptoms to your insurer and physician.
The claim examiner will analyze the medical records. If you notify the insurer that you cannot leave the home, but the medical records show you are a member of a weekly football league, the LTD insurance company will consider the claim fraudulent. Unless the limitations, signs, and symptoms are continuous and constant, it is advisable to avoid using words such as "always" or "never" when describing them.
Additionally, limit social media usage while the application and claim for benefits are pending. Most individuals glamorize their lifestyle on social media and do not show their limitations or bad days. While your claim is pending, the LTD insurance provider could track your social media platforms, looking for proof that you can work.
Disability claimants can sometimes overstate their capabilities. It could be hard to admit that they cannot do specific things. Nevertheless, if you minimize or gloss over your functional limitations, the insurer can assume that you can work.
If the insurance provider or physician inquires about your everyday routine and hobbies, be frank. For instance, avoid listing basketball as your hobby if you have not played it in years. Moreover, be specific; watching sports from the comfort of your home differs from sitting on a beach. You should also include a rest period if it is part of your daily routine.
Failing to Adhere to Your Doctors' Recommendations
You should see your doctor regularly and follow their recommendations to the best of your ability. LTD insurance companies sometimes deny a disability claim because you ignored your doctor's recommendations.
You should follow your physical guidelines. Otherwise, your insurer could claim that your health condition has improved. They can also urge that the health condition was not as serious as claimed.
Here are some things to do to keep the validity of your LTD claim:
- Keep in touch with your doctor and alert them if your health condition worsens or improves.
- Ensure you attend every recommended appointment associated with your health condition, including rehabilitation and therapy.
- Visit recommended medical experts—If your primary doctor recommends consulting another physician, do so. Otherwise, the insurer might claim that you do not want to improve your health condition by avoiding the recommended health practitioner.
- Take your recommended medication—Taking the recommended dosage of over-the-counter or prescription medication is key.. Your insurer could argue that you worsened the condition by failing to take the medication.
- Preserve evidence— You should preserve all relevant documentation regarding your health condition.
- Consider consulting an attorney to increase your chances of obtaining more satisfactory LTD benefits.
- Maintain your medical journal —Sometimes it can be challenging to recall everything you experienced following your disability. Keep track of the recovery process in your journal, including your prescription, medical appointments, the degree of pain you have endured, and setbacks or improvements related to your condition. You can use the journal as proof in your LTD claim.
You Should Also Refrain from Activities that Can Worsen Your Health Condition
Sometimes physicians may advise you to avoid specific activities that could worsen your condition, such as exercise, strenuous activities, or playing sports. The insurer could be reviewing your social media platforms or watching your activities. If you ignore things your physician warned you against, the insurer could consider you to be attempting to cheat them. The insurer does not know it takes time to recover from the activity, or whether you experience pain during it.
When your LTD insurer requires you to complete an activity log, it means the company has been watching you.
Do Not Use the LTD Insurance Company-recommended lawyer When Seeking Social Security Benefits.
Long-term disability insurance firms want you to receive Social Security disability benefits. Social Security Disability Insurance (SSDI is an insurance program funded by self-employment taxes and payroll taxes for a disabled adult who can no longer work. When you work and pay taxes into the Social Security Trust Funds, you gain insurance coverage that can support you after you become disabled and want to draw benefits.
The insurer does not want to help you because they have your best interests at heart. They have a financial motive for you to obtain the social security disability benefits, and they have an incentive to keep tabs on you and your case. They realize these agendas if they can choose for you who will represent you in your case. Typically, your LTD insurer will recommend a law firm to represent you in your claim, primarily if the insurer sells policies governed by ERISA law.
You should be cautious when using these legal counsels. There are cases in which these attorneys have guided applicants to select specific disabilities on their Social Security Disability Benefit applications, only to find that the disability sections later made it challenging to establish their claims.
Applying Without Medical Evidence or Submitting Your Application Without All the Evidence
ERISA protections assist employees by imposing requirements on insurance companies. The insurer has a duty to policyholders and should make decisions in the policyholders' best interests. Nonetheless, the policyholder has to prove they qualify. Applying without evidence or adequate medical documentation can result in claim denial or delays.
When applying for your disability insurance benefits, your insurer will require you to sign a medical records release (HIPAA release). Your medical records help the insurer understand your work limitations and the seriousness of your health condition. You should obtain comprehensive medical records from every healthcare provider who took care of you after the incident that led to your disability. The record should contain the following:
- Your diagnosis
- Treatment history
- Current symptoms
- Functional limitations
Request that your physician be specific; vague phrases carry little weight. Your insurer wants to see measurable findings, not just symptoms. For instance, a physician's note indicating that you cannot stand or sit for long due to a lumbar disc herniation, as verified by the magnetic resonance imaging (MRI), carries more weight than claiming that you complain of fatigue.
Please note that your insurer might not order your records or might decide before receiving the complete copy of your medical records. Sometimes, missing records contain essential details that support your LTD claim.
Spend quality time completing your application form and double-checking all information for accuracy. Consider hiring a qualified attorney who can review your application before submitting it. Keep copies of everything you submit. Respond promptly to requests for more information and maintain comprehensive records of every communication with the insurance provider.
If your insurance provider denies your claim, request a copy of the insurer's file. Either you or your awyer should review whether the file is complete. At that point, you can add missing details to the file; you cannot add more evidence to the record after the claim is appealed at the federal court.
Failing to Hire a lawyer
One of the decisions to make when applying for your LTD benefits is whether to hire a lawyer or represent yourself. While the idea of self-representation might seem cost-effective and empowering, it can have dire consequences that affect your claim's outcome. Here is why you need an attorney:
- Attorneys are objective —Sometimes, when applying for your LTD benefits, you might be caught up in emotional situations that leave you too overwhelmed to regulate. However, being emotional can affect your judgment and decision-making, leading to antagonistic behavior when dealing with the LTD insurance provider. On the other hand, a lawyer provides objective and strategic advice and guidance that can help you avoid making a decision driven by pride, the heat of the moment, anger, or fear.
- Strategic advantage—LTD claims application goes beyond being right. It is also about who makes the most compelling arguments. Experienced lawyers know how to plan and think strategically. They know what to anticipate, the evidence to present, and how to respond to the insurer's setbacks.
- Access to different resources—Lawyers have access to networks and tools that a self-representing person might not have, including a network of paralegals and expert witnesses who can increase your chances of receiving satisfactory LTD benefits. For instance, your lawyer can retain a doctor to strengthen your claim.
- Artificial intelligence is not a substitute for seasoned legal representation—For persons considering self-representation, it can be tempting to depend on AI. After all, artificial intelligence can draft your legal documents, perform legal research, analyze case laws, and predict case outcomes. However, AI's reliability depends on the currency and quality of the information it is trained on. If AI tools are not updated in real time, they can provide incorrect information.
When hiring an attorney, experience in ERISA is vital. Examples of the impact of working with an inexperienced attorney on your case include settling your case for less than its worth, failure to gather relevant evidence, and missed deadlines.
You should consider consulting an LTD lawyer when any of the following apply:
- Your insurer slows or denies your claim without justification
- You should undergo an independent medical examination— Insurance companies often request IMEs to assess your disability. While the examinations might be routine, the insurer can use them to discredit your claim. Hiring a trained lawyer can educate you about your rights regarding IMEs, esure the evaluation is fair, and prepare you for the evaluation.
- Your LTD claim is disputed—Sometimes, an insurer disputes the severity of your health condition or claims that you do not satisfy the definition of disability based on the insurer's policy definition or disability. In this case, your attorney will ensure your injuries and health conditions are well represented, with expert witnesses from doctors to prove the claim.
- You are making an LTD caim and require professional assistance with your caim process
- You require a person to assist you in obtaining and documenting sound medical records and facts from medical practitioners
- You are dealing with a complicated process with different eves of coverage periods or group policies
- You are preparing to file a claim or sue to obtain compensation
Depending Heavily on Your Employer's Opinion
You should not assume you have adequate evidence for your LTD claim just because your employer said you are too sick to work. The LTD insurance provider is the one paying your benefits, not your company. The insurance firm will also determine whether you meet the policy's definition of disability.
Additionally, you should not rely on your human resources manager's advice. Although the human resources manager might have your best interests at heart when offering the advice, they are untrained in interpreting insurance policies and do not have influence over your LTD insurance provider.
You should understand that your insurer and employer are separate entities, and it is not required that the insurance firm honor the guarantees your employer makes.
Find a Qualified ERISA Disability Benefits Attorney Near Me
As a disabled employee, your ERISA lTD application is a key step i your disability benefit claim. If your application has errors, it can result in significant delays or the insurer is more likely to deny the claim. Leland Law can help you protect your rights and secure the benefits you drive and have earned. We can also gather and organize your medical records in a manner that supports your claim, ensure you do ot miss the deadline, handle your communication with the insurance provider, and build a strategy that suits your job history and health condition. Please contact our California office at 866-449-6476 to schedule your free consultation.
