Common Reasons for ERISA Long-Term Disability Denial in Virginia

If you become disabled and unable to work, you are likely to expect that you will get cover under your employer’s long-term disability plan. All too often, however, insurance companies will find a reason to deny you cover.

Alternatively, you may initially receive disability benefits, but then receive notice that the insurance company is discontinuing your benefits.

These are some common reasons for ERISA long-term disability insurance denial in Virginia, most of which are based on policy provisions designed to avoid paying out benefits in as many situations as possible.

Defining Disability Under ERISA Plans

ERISA provides no standard definition of disability, which can make it even more difficult to meet plan standards, which vary widely. Some common definitions of disability include the following:

  • Inability to perform tasks necessary for individuals’ jobs
  • Inability to work in jobs based on individuals’ education, experience, and job history
  • Inability to work in any type of job

To make it even more confusing, some insurance policies change the definition of disability even after individuals have received benefits for a certain period of time. For example, the insurance company first may require that individuals only be unable to work in their specific jobs, but after paying out benefits for 24 months, the insurance company then may require a showing of a complete inability to work in any type of job.

Whatever the relevant definition of disability may be, individuals must provide sufficient evidence to support their claim for benefits. It can be difficult to gather all of the medical records, especially when many different providers are involved.

Plus, doctors sometimes may orally give a diagnosis or recommendation during an appointment, but that information may not always translate into patients’ written records. This can be frustrating and result in a more time-consuming process for individuals as they struggle to get the records necessary to support their claims.

Other Reasons for Benefits Denial or Termination

Aside from denials or terminations of benefits related to meeting the definition of disability, insurance companies may deny or terminate benefits for other reasons.

For example, many disability benefit plans contain offset provisions, which reduce individuals’ eligibility for benefits according to the amount of other disability benefits that they receive, such as Social Security disability benefits or worker’s compensation benefits.

Some insurance policies even require that individuals apply for Social Security disability benefits as a condition of continuing to receive long-term disability benefits.

Other disability insurance policies may contain caps on the amount of benefits that can be drawn, whether these caps are based on percentages of individuals’ salaries or certain dollar limits.

Many policies also have mandatory waiting periods, which means that individuals are not entitled to disability benefits until a certain number of days have passed since the date that they became disabled and unable to work. All of these situations constitute common reasons for ERISA long-term disability insurance denial in Virginia.

Let a Virginia ERISA Disability Attorney Assist You

While you have the right to appeal common reasons for ERISA long-term disability insurance denial in Virginia, the appeals process can be complex and time-sensitive.

You should consider setting up an appointment with an experienced ERISA disability claims attorney as quickly as possible following the denial or termination of your disability benefits. This will ensure that you do not miss any deadlines in your ERISA disability case.