Denied applications are one of the most common reasons people seek help from Augusta disability lawyers. Employer-provided long-term disability policies follow the guidelines of a federal law called the Employee Retirement Income Security Act. ERISA provides guidelines that claims administrators use to assess all disability applications. Most of the claims administrators who evaluate disability applications also work for insurance companies, which may present a significant conflict of interest. Claims administers often deny claims even when there is clear evidence of disability in order to save the insurance companies money. Claims administrators may deny your claim for numerous reasons, some valid and others invalid. In order to present a solid appeals case at the administrative level, it is important to understand why your claim was rejected.
Lack of Medical Evidence
Common reasons for denied claims tend to revolve around a lack of supporting medical evidence. The claims administrator must have proof of your regular medical treatment in order for your long-term disability case to succeed. You will need to make regular visits to your primary care physician and specialists to produce a consistent record of suffering. Psychiatric conditions warrant regular consultation with a mental health provider. If you are physically impaired, you should receive regular objective tests, such as MRIs and CT scans, in order to create a clear timeline of impairment. Missing medical records are another common reason why many disability claims are denied. You may be denied even if the insurance company has not obtained all your records. Ask your disability insurance carrier for a list of all records requested and received and provide any missing records where appropriate. Augusta disability lawyers can often facilitate communications with insurance carriers that are presenting difficulties. You should also obtain the opinion of your treating physician in a doctor’s statement. The doctor’s statement should be as detailed as possible with regard to your work-related limitations. Forms from your insurance company are designed to create a picture of your limitations that results in denial, so have your doctor write his or her own letter describing how your impairments limit your capacity to work. Augusta disability lawyers may be able to help you procure these letters.
The Definition of Disability
In many cases, you may be denied for long-term disability benefits if you do not meet your policy provider’s definition of disability. “Own occupation” LTD policies define disability only as being able to carry out the duties of your occupation and are far more lenient. “Any occupation” policies define disability as the inability to perform the duties of any job in any field. Some plans switch from own occupation standards to any occupation standards after two years or another length of time. You should also make sure that your condition is not included in a list of your provider’s excluded conditions. Some medical impairments related to pre-existing conditions or substance abuse are not covered. Other conditions that are unable to be tested objectively, such as chronic fatigue syndrome, may result in limited benefits.
Video Surveillance Inconsistencies
It is common for there to be a video surveillance investigation during the LTD filing process. If investigators obtain footage that shows you engaging in activities inconsistent with your disability allegations, your claims may be denied. Even if your condition lessens and intensifies from one day to the next, video surveillance may still be used to deny your claim. Augusta disability lawyers may offer guidance when it comes to complying with your doctor’s restrictions and arguing against footage that seems to call your disabled status into question. Even after your claim has been approved, video surveillance may still be used against you to terminate your existing benefits. It is best to always act in accordance with your doctor’s recommended activity restrictions, from using a cane to not lifting heavy objects around the house. Not only can taking such actions put your health in jeopardy, but disability claims administrators can use them to suggest that you are not truly unable to perform the activities related to your job. Investigators may even follow claimants outside the home to look for signs that they are exerting themselves beyond the limitations stated on their disability claims.
It is important to note when your claim was filed and when the appeals process began. ERISA allows 180 days to make an appeal after your initial denial. During that time, it is advisable to work with Augusta disability lawyers to gather a strong administrative record with favorable evidence to support your case. If you miss the 180-day deadline, you will not be permitted to bring a lawsuit against your insurer in federal court. For this reason, it is best to file your appeal as soon as possible after receiving a denied claim. You should also submit all medical records as soon as possible, since the courts are only able to consider material within the administrative record. If you have not submitted this information to your insurance company, it is unlikely that it will be allowed in court.
Contact Augusta Disability Lawyers
The disability application process is difficult, and it is not uncommon for first-time applications to be denied. The appeals process can be navigated effectively with the right strategies in place. Contact us for more information on filing your disability claim or starting the appeals process. Augusta disability lawyers may be able to help you turn a denied disability claim into a successful appeal for long-term disability benefits.