If you become disabled you may be covered by a long term disability (LTD) plan. You may have signed up for one through your employer or you may have purchased one on your own. In general, a set of federal laws called the Employee Retirement Income Security Act (ERISA) governs many of these plans. The LTD plans are also governed by contract law. Each plan will contain provisions regarding their definition of “disabled” and the scope of the plan’s coverage. A typical plan will pay part of your lost wages if you are unable to perform each and every function of your own occupation for the first twenty-four months of your disability. After twenty-four months your plan will likely switch the standard from unable to perform your old occupation to unable to perform any occupation. This basically means the insurance company will deny your claim if they feel there is a job in the economy that you can perform. Most plans give the insurance company the discretion to determine your eligibility.
Insurance companies also have a laundry list of reasons why they will deny your claim. Reasons include not being continuously disabled throughout the elimination period, a pre-existing medical condition, or failure to be under the care of a physician. Another reason why the insurance company may deny your claim is failure to comply with insurance companies requests. Since you are claiming to be too disabled to work, your physical and mental medical records are directly at issue. This means the insurance company can require you to see a doctor and they will be able to obtain all medical records. The insurance company will likely require you to undergo medical exams by doctors who are hired to find that you are not disabled. They can also demand that you fill out forms describing your medical condition. If those forms are not returned in a timely manner the insurance company can terminate your existing payments or deny your claim at the beginning.
The insurance company will use your failure to fill out their forms or they might claim that your medical records do not substantiate your claimed restrictions and limitations and then deny your claim. It is important to contact an attorney at the onset of your claim to protect yourself from errors that may lead to a denial or termination of benefits.