First-Time Applicants Are Often Denied Disability Benefits

Many people who apply for Social Security disability benefits are denied. They are confused and unsure what to do because they were counting on disability benefits to help them support themselves and their families. We understand your frustration, and we want to help.

Our Kansas City long-term disability attorney at the Law Office of Kevin J. McManus represents clients nationwide who are appealing Social Security disability denials. Contact our office for a free review of your denial letter by calling 816-203-0143 or contacting our law office online.

Why Did the Insurance Company Deny My Long-Term Disability Claim?

Long-Term Disability Attorney in MO & KSWhen you apply for long-term disability benefits, you must prove that you have a physical or mental disability that meets the definition for being disabled in your long-term disability policy. You must also meet the other requirements to qualify for long-term disability benefits in the LTD policy. You will be required to complete a lengthy disability application and provide medical records and opinions from your doctors regarding your ability to work.

A long-term disability insurance company can deny a claim for many different reasons. Common reasons for denying long-term disability claims include:

  • Your condition does not qualify as a disability under the policy terms
  • The insurance company claims you are not disabled because you can perform either your “own occupation” or “any occupation”
  • You have a pre-existing condition that does not qualify under the policy terms
  • You have not worked at your employer long enough and are still in the elimination period
  • Your medical records are insufficient or do not establish a qualified disability
  • You failed to submit accurate and complete records
  • Your application contains errors or is incomplete
  • You did not respond to requests for additional information or cooperate with the claims process

There is a good chance that you will need to appeal your long-term disability claim. The appeal process for a long-term disability claim is very important.  Many employer-sponsored long-term disability plans are governed by a federal law known as ERISA. ERISA has certain special rules that tilt the scales in favor of the insurance company. For this reason, it is critical that you consult with and hire an attorney experienced in ERISA to handle your long-term disability appeal.

When Do I Appeal a Denial of Long-Term Disability Benefits?

The insurance company sends applicants a denial letter explaining why their disability application was denied. The letter also contains information about filing an appeal.

Most long-term disability plans governed by ERISA give you 180 days to file an appeal.  However, you need to read your denial letter carefully to find out when your appeal is due.  If you do not file your appeal before the deadline, you may be barred from filing an appeal in the future and receiving long-term disability benefits.

How to File an Long-Term Disability Appeal

Requesting your claim file is the first step in the disability appeals process. Under ERISA, the insurance company is required to provide you will the entire claim file within 30 days if you request it after a long-term disability denial.

Next, you should talk to doctors and ask them if they support you in your disability.  It is very difficult to win an appeal without medical support.

Lastly, you should seriously consider talking to our experienced ERISA long-term disability attorney before filing your appeal.  Usually, most long-term disability policies provide for only one right to an appeal.  If your appeal is denied, you may be barred from asserting new information later in the case.  This means you need to assert all medical support and legal arguments in support of your claim at the appeal stage and you need to point out all inconsistencies and errors the insurance company made in denying your appeal. 

Unfortunately, many disability claims are denied at the appeal stage.  After all, the same insurance company that denied your claim is the one that typically reviews the appeal. However, don’t give up hope. Under ERISA, you have the right to file a lawsuit in federal court if your long-term disability claim is denied on appeal.

Do You Need Our Long-Term Disability Lawyer to File an Appeal?

You are not required to hire our lawyer to file an appeal for disability benefits. However, if your initial disability application is denied or your long-term disability benefits are terminated, working with our long-term disability attorney gives you the best chance of winning your case.

Our disability attorney handles all of the paperwork, evidence, and preparation necessary for a disability appeal. Our attorney will prepare the appeal not just for the insurance company, but also for a potential lawsuit if the appeal is denied. With the help of our attorney, you can build the strongest case for winning your long-term disability appeal.

Filing an ERISA Long-Term Disability Lawsuit in Federal Court

If your long-term disability appeal is denied, ERISA gives you the right to file a lawsuit in federal court to recover your long-term disability benefits. Under ERISA, the rules governing lawsuits to recover long-term disability benefits largely benefit the insurance company. 

In general, ERISA does not allow discovery (including taking depositions or statements from insurance company, doctors, family members or other witnesses), and there are no juries.  A judge will decide the case based on motions filed by the attorneys.  The only evidence you are allowed to use to make your case is what was in the claim file, including what you filed with your appeal. 

Even worse, in most long-term disability benefit lawsuits governed by ERISA, the judge gives the insurance company’s decision the benefit of the doubt. This is called the “abuse of discretion” standard.  This requires you to prove that the insurance company abused the discretion that it was given under the terms of the long-term disability policy.  This is not your typical breach of contract case! 

For these reasons, it’s strongly recommended that you contact our experienced long-term disability attorney as soon as possible after a denial. Claimants represented by counsel have a better chance of winning their appeal than individuals who represent themselves.

Our long-term disability attorney works with clients to obtain evidence and make legal arguments to support their claim that claimants may not be aware of if they represent themselves.

Contact Our Long-Term Disability Lawyer for More Information

Our law firm represents clients throughout the country in long-term disability appeals and lawsuits. Contact our office for a free review of your denial letter by calling 816-203-0143 or completing our online contact form.

 

 

Kevin J. McManus
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Kevin McManus is a nationally recognized personal injury and long-term disability attorney in Kansas City, MO.
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