Knowing how to handle long-term disability denials in Ohio begins with retaining an experienced disability lawyer. Denial cases are particularly complicated. Understanding policy terms and eligibility requirements can be overwhelming and confusing—with a significant margin for error for claimants unfamiliar with the process.
Schedule a free consultation with experienced disability lawyers in Ohio today to discuss a strategy for your appeal. We understand the claims process proficiently and provide a greater chance of having your long-term disability claim approved.
Common Reasons for Long-Term Disability Denials
There are many legitimate reasons why an insurance company may deny a long-term disability (LTD) claim, with as many illegitimate ones. The most common reason for long-term disability denials in Ohio include:
- Application Errors: Due to the intricate nature of LTD claims, mistakes are common when completing the claims application form. Application errors include not filing on time, missing information, or incomplete forms.
- Policy Exclusions: Your policy may exclude certain illnesses and injuries that are valid grounds for denial of claims. For example, insurers commonly include exclusions for self-inflicted injuries that lead to disability. They also generally exclude receiving disability benefits if you sustained your injuries while engaging in criminal activity.
- Insufficient/Missing Medical Evidence: Lack of proper medical documentation is another common reason for long-term disability denials. Medical records failing to demonstrate your disability clearly or failure to provide viable medical statements from your doctor may lead to denial.
- Not Meeting Definition of Disability: Insurance policies define “disability” using specific criteria outlined in your policy. If you do not meet the actual definition of disability outlined in your policy, your claim will be denied.
- Video Evidence Countering Disability Claim: Insurers often employ investigators to conduct video surveillance of disability applicants to verify that application claims are truthful. If they obtain video evidence of you engaging in activities that demonstrate an exaggerated disability, your claim will be denied.
- Social Media Evidence Disputing Disability: Insurance companies also use private investigators to stalk claimants’ social media accounts to find ways to deny claims. Insurers often deny LTD claims because posts, photos, and video content contradict the symptoms and limitations reported to the company.
The claims adjuster may require you to submit proof that you’re undergoing continued medical treatment. Not following your treatment plan is a valid reason for long-term disability denials in Ohio. If a physician prescribes referrals with specialized care outlined for your injuries and you refuse to make and maintain your appointments, you can expect a rejection letter.
If your LTD claim was denied for reasons not listed or you disagree with their decision, you must contact a long-term disability lawyer immediately. They will explore your opportunities for appeal.
How to Handle Long-Term Disability Denials in Ohio
You have a minimum of 180 days to file an appeal to your long-term disability denial in Ohio. You’ll need to check your claims procedure or summary plan description to determine if your plan provides a more extended filing period for LTD claims.
Consult a Long-Term Disability Lawyer in Ohio
Handling long-term disability denials in Ohio involves first consulting an experienced disability lawyer. These lawyers work on a contingency fee basis and offer clients no out-of-pocket or upfront costs. If they take your case, they genuinely believe they will win it. Otherwise, they do not get paid.
They aren’t going to instill false hopes or waste resources and time fighting to appeal disability denials that have no shot of approval. That means there is zero financial risk for you to speak to a long-term disability lawyer to determine if you have a legitimate appeal claim and how to navigate the convoluted process.
Review and Understand Your Long-Term Disability Denial Letter
Your lawyer will carefully review your long-term disability denial letter with you to ensure a solid understanding of why you were denied. Many LTD claims are rejected due to technical issues and not your claim’s merit.
Your long-term disability denial letter will instruct how and when to file your appeal. Your attorney will ensure the process operates within all stated deadlines.
Collect Missing Documentation
If your long-term disability denial letter outlines the cause as inadequate or missing information, you and your lawyer must gather what is missing. It’s common for insurers and plan administrators to drop the ball on properly obtaining all relevant medical records. Determine what medical evidence is incomplete or missing. Your attorney will oversee this process.
Secure a Copy of Your Long-Term Disability Insurance Policy
Get a copy of your long-term disability policy plan documents, including your summary plan description. You can usually obtain this from your human resources (HR) department. However, if your company provides group insurance, you may get it directly from your insurer.
If your insurer or HR department fails to provide your LTD plan documents, you may need to request them in writing via certified mail. Remember to get a return receipt. The plan administrator must provide these documents under the federal law—the Employee Retirement Income Security Act (ERISA).
Ask Your Doctors for Written Opinions
Having written opinions from your primary care physician and treating specialists about the work-related limitations and restrictions your injuries cause you is vital to your case. Your disability lawyer will carefully craft intentional questions based on the circumstances of your LTD claim to ask your doctors.
The opinions of the physicians treating you are pertinent to convincing an insurer of your long-term disability. Having a favorable physician’s written opinion is invaluable to your approval.
How Will a Disability Lawyer Help?
A long-term disability lawyer will provide peace of mind when you trust them to handle the process of appealing your denied LTD claim. Hiring a disability attorney is helpful because:
- They retain an understanding of complex disability laws and claims regulations
- They provide evidence collection, preservation, and analyzation
- They have honed negotiation skills to maximize benefits
- They possess litigation skills in the event your claim requires a lawsuit
- They provide protection against bad-faith insurance tactics
Schedule a free consultation with trusted disability lawyers in Ohio to have your denied claim evaluated. You’ll want to determine a strategy to appeal your long-term disability claim denial with an experienced legal professional.
