Here is a list of your legal rights concerning your claim for long-term disability insurance benefits. This is not a complete list but is intended to highlight some of your most important rights.
Seven of Your Legal Rights Concerning Your Claim for Long-Term Disability
You Have the Right to Buy an Individual Policy Directly from an Insurance Broker
Long-term disability insurance is often available as part of a group plan with an employer. However, consider purchasing an individual policy – even if your employer provides disability coverage at no or little cost. That’s because, with few exceptions, ERISA law governs group disability insurance plans you obtain through your employer. Unfortunately for claimants, ERISA law heavily favors the insurance company.
Under ERISA, you do not have the right to have your case heard by a jury of your peers, you cannot testify at trial, and you will probably not have the right to present additional evidence. Also, winning an ERISA lawsuit often requires a higher standard of proof than disputes involving an LTD policy you bought individually. If you have individual disability insurance and your insurance carrier denies your claim, you have the right to file a lawsuit against the insurance company in state court.
You Have the Right to Submit Your Medical Records
Many claimants believe it is the insurance company’s duty and obligation to get their medical records after the claimant has identified all medical providers in the application for benefits. However, in a long-term disability claim, the claimant bears the burden of proof.
Before you file your long-term disability claim, request all relevant medical records from your doctors. The fate of your claim will depend on whether your doctors support it, so you should see what is in your medical file before filing a claim. Plus, you may discover incorrect information in your medical records. Ask your doctor to correct any misstatements in your medical file.
Medical record requests overburden many doctors’ offices. When one of your doctors does not respond to the insurance company’s medical record request, those records do not become part of the claim file. If ERISA applies—as it does to most group plans—the federal court judge’s decision on a lawsuit will be based on what is in the claim file.
You Have the Right to Seek Medical Treatment from Any Doctor You Prefer
If you request all your medical records from your doctors and those from one or more of your doctors do not support your claim, you have the right to change doctors. Consider changing doctors if your doctor tells you they will never fill out any paperwork for your insurance company. The LTD insurance company will constantly ask your doctors for updated medical records, call your doctor’s office with questions, and ask your doctor to fill out Attending Physician Statements. If your doctor is unwilling to respond to these requests or tells you they do not support your disability claim, you may seek treatment from another provider. It would be extremely difficult to be approved for benefits if your doctor does not support your disability claim.
You Have the Right to a Copy of Your LTD Policy and Plan
Every disability policy and plan is unique. The disability “policy” is the document from the LTD insurance company setting out the specific disability coverages; the “plan” is the agreement between you and your employer regarding the coverages to be provided as part of your employment. When filing an appeal (or even the initial application), review the long-term disability policy and plan your employer previously provided. If you no longer have a copy of the policy or plan, request a copy from your Human Resources (HR) representative and your LTD insurer.
Related: Why It’s Important to Get a Copy of Your Long-Term Disability Policy or Plan
You Have the Right to a Copy of the Insurance Company’s Complete Claim File
You also have a right to get a copy of your claim file. If your insurance company has denied or terminated your claim, you should immediately contact your insurer to request a complete copy of your claim file. Reviewing your claim file will help you determine if there is additional evidence you need to submit with your appeal. You must appeal within the appeal deadlines, but you should also take care to submit the evidence you need to win your case with the appeal.
You Have the Right (If Not The Duty) to Appeal Your Long-Term Disability Denial
If you are part of a group disability plan, you may be required to file an appeal. If you have an individual policy or are a government or church employee, you may not be required to file an appeal. An attorney experienced in LTD claims can help you determine whether your appeal is mandatory or optional. If optional, an attorney can further advise you whether you should file an optional appeal.
You Have the Right to Hire Any Attorney You Choose to Represent You
Insurance companies like to collect premiums but don’t like to pay claims. To receive the benefits you deserve, you must do everything possible to satisfy your burden of proving you meet the insurance company’s definition of disability. If the insurance company denies your claim, seek professional help. Your HR contact may offer to help you, but HR representatives are not always aware of the time limits and amount of proof necessary to support an LTD appeal.
Schedule a Free Case Review to Discuss Your Denial with a National Long-Term Disability Attorney
If your long-term disability claim has been denied, Ortiz Law Firm can help. Nick Ortiz is a national long-term disability attorney who has been appealing disability insurance claim denials since 2005. He and the experienced legal team at Ortiz Law Firm will review your case, gather the necessary evidence, and fight to get you the benefits you deserve. Don’t give up on the benefits you deserve – Ortiz Law Firm will work tirelessly to overturn the decision and secure your rightful disability benefits. Call (888) 321-8131 to schedule your free case review today.
