Long-term disability benefits may have been offered as one of the perks in your employment contract. In addition to other types of insurance, these benefits protect you in the event the unexpected occurs. If an injury or illness does prevent you from working, long-term disability payments can provide a lifeline to ensure you and your family are provided for. However, it is not uncommon for insurers to deny or dispute benefits. The following highlights some of the most common reasons you are likely to have trouble collecting on your claim.
Denial of Long-Term Disability Benefits
According to the Centers for Disease Control and Prevention (CDC), more than 60 million people currently live with some type of disability. This amounts to roughly one out of every four Americans. Disabilities can impact your physical health along with your cognitive abilities and may have occurred as a result of a chronic condition or due to sudden and unexpected illnesses or injuries.
If you have been diagnosed with a disability that impairs your ability to work, employer-sponsored benefits may be available. Unfortunately, obtaining these benefits can provide challenging. Insurance companies are in business to make money and one of the ways they do this is by reducing payouts. While your rights to benefits are protected under the Employee Retirement Income Security Act of 1974 (ERISA) and other state or federal laws, there are common reasons in which a claim may be denied. These include:
- Lack of medical care: It is crucial prior to filing a claim to seek medical attention for your condition. If there is no record of a medical diagnosis or previous treatments, your claim will likely be denied.
- Excluded conditions: Insurers often place limits on the types of conditions covered, particularly when a disability is related to a pre-existing condition.
- Failure to submit appropriate documents: In addition to your application, you will be required to submit other evidence, such as medical records and statements from your provider. Not doing so will result in your claim being denied.
- Failure to file or respond within appropriate deadlines: Disability claims are time sensitive, requiring you to submit your application and other documents within appropriate time frames. Failure to respond to correspondence from the insurer can cause you to miss certain deadlines.
- Evidence which invalidates your disability claim. When you file a claim against an insurer, an investigator will be assigned to your case. In addition to viewing surveillance video from your job, they are likely to also monitor online activities, including social media posts. If they can find evidence showing you engaging in certain types of activities, they can argue you are not truly disabled.
Contact Our Santa Clara County Attorneys Today
If you have been denied long-term disability benefits through your job, reach out and get the legal guidance you need from the Jachimowicz Law Group. Contact our skilled San Jose ERISA attorneys at our office today to request a free consultation.
Sources:
https://www.cdc.gov/media/releases/2018/p0816-disability.html
https://www.dol.gov/general/topic/health-plans/erisa
