Common Reasons for ERISA Long Term Disability Insurance Denial in Washington DC

It is common for insurance companies to deny ERISA long-term disability (LTD) claims filed in Washington, DC. Long-term disability policies provided by an employer are governed under ERISA, which stands for the federal Employee Retirement Income Security Act.

Disability claims are evaluated by insurance administrators working to keep their costs as low as possible, so these claims are often denied even in situations where they clearly seem to be warranted.

ERISA provisions enable denied applicants to appeal their decisions. To present the best possible case in an administrative hearing or in federal court, it is helpful to understand common reasons for ERISA long-term disability insurance denial in Washington DC. Learn more about the common reasons for ERISA long-term disability insurance denial in Washington DC by calling a knowledgeable attorney. An attorney could explain your rights and legal options.

Claims Are Frequently Denied Due to Lack of Sufficient Medical Evidence

To obtain long-term disability benefits, it is vital to provide proper evidence of medical conditions. It will initially be necessary to ensure that the person seeking benefits visits doctors on a regular basis. This could include specialists and physical therapists. The doctors could order MRIs, CT scans, x-rays, and other tests which could serve as evidence.

In some cases, a claim may be denied because the insurance company simply has not received all of the applicable records, so it could be helpful to ask for a list of records received to check if the insurer has access to all the available evidence.

Since the opinion of the doctors could be extremely important in determining eligibility, it may be a good idea to have the applicant’s doctor prepare a detailed written statement regarding the patient’s medical limitations as they relate to employment. The statement typically describes how these limitations prevent the applicant from performing job duties.

An attorney could request this statement on behalf of the applicant or help locate a doctor who is able to do so if the patient’s doctor refuses to provide this type of detail. Experienced Washington DC lawyers who are familiar with the¬†common reasons for ERISA long-term disability insurance denial could plaintiffs gather medical evidence.

Applicant Does Not Meet the Definition of Disability in the Policy

It could be important to review the policy’s fine print to see the exact definition of disability to determine whether an applicant qualifies. Some long-term disability policies may consider an applicant disabled if that person is deemed unable to fulfill the duties of a specific occupation. Others might not consider an applicant disabled until that person is unable to perform any type of job.

The process could be more confusing since a policy could transition from one standard to a more narrow standard after a certain period of time.

It may also be important to check the policy description to look for conditions that may be excluded or limited. This could include those based primarily on complaints of pain (i.e. fibromyalgia) as compared to those with objective damage that is visible in x-rays or other physical evidence.

An attorney in Washington DC could assist a person in examining their ERISA Long Term Disability Insurance policy to see if their case has any common reasons for a denial.

Video Surveillance Sometimes Reveals Evidence Contradicting a Claim

It is not uncommon for those seeking or receiving long-term disability benefits to be placed under video surveillance at the request of the insurance company. If investigators record an applicant performing activities that belie disability claims, the application could be denied or benefits could be stopped.

It may be wise for anyone seeking disability benefits to follow doctors’ advice when it comes to restricting activities and using assistance such as a cane or walker.

An ERISA Long Term Disability Insurance Claim May Be Denied if Deadlines are Missed

While it may sound simple, it could be difficult to determine the deadline for submitting information. On certain occasions, information may be submitted on time and may not be received by the deadline because it was sent to the wrong place.

An experienced long-term disability insurance attorney could help ensure that all paperwork necessary for applications and appeals is filed properly and in a timely fashion with the right documentation.

ERISA law limits evidence judges hearing cases on appeal to that which was presented at the administrative hearing, so it may be vital to ensure that the right evidence is presented at the appropriate time.

For further detail about common reasons for ERISA Long-term disability insurance denial in Washington DC, it may be helpful to schedule a consultation with a lawyer familiar with long-term disability insurance claim appeals.