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Signs Your Long Term Disability Claim May Be Denied (And What To Do About It)

Have you been receiving long term disability insurance benefits but notice the insurance company has recently begun acting strange? Are you worried the insurance company might deny your claim and cut off your benefits? Here are the top signs that your long term disability claim may be denied and recommendations on how to prevent a denial.

The Insurance Company Scheduled You To See Its Doctor

Recently, Long Term Disability Insurance Companies have been sending disability beneficiaries to see their doctors as part of the claims review process. These appointments are not to help your medical condition. Rather, it means the insurance company is looking for a reason to deny your long term disability claim.

What to do: Contact a long term disability attorney to discuss whether you have to attend this appointment and determine a strategy to protect your benefits.

Your Benefits Are Transitioning From “Own Occupation” Benefits To Any “Occupation Benefits”

Most long term disability insurance policies provide two periods of disability benefits. The first period is called “own occupation” benefits. These benefits are paid when someone is not able to perform the duties of their own job. After the “own occupation” benefits are paid for a period of time (usually about 2 years) the policy transitions to “any occupation” benefits. “Any occupation” benefits are paid when an individual is unable to perform the duties of any job. For those receiving long term disability benefits, the transition from “own occupation” to “any occupation” benefits is a common time for claims to be denied.

What to do: 1. Understand your policy 2. Find out if your policy transitions from “own occupation” to “any occupation” benefits 3. Know the definitions the insurance company is using and when the transition will occur 4. Discuss this changing definition with your doctor to find out whether she believes you can work in any capacity  5. Make sure you have applied for Social Security Disability benefits 6. Finally, contact an attorney with any questions or concerns

You Have Been Assigned A New Claims Manager

A third sign that your claim may be denied is if the insurance company assigns you a new claims manager. Your claims manager is your primary point of contact with the disability insurance company. When a new claims manager is assigned, it can be a sign that the disability insurance company is looking to deny your claim. If your new claims manager is rude, does not understand your medical condition, or takes an aggressive approach with you, it may mean that your claim will be denied.

What to do: 1.Do your best to establish a good relationship with the new claims manager 2. Try to explain your medical condition and how it impacts your ability to work 3.  Make sure any paperwork requested is completed on time by both you and your doctors 4. Document conversations with your claims manager in writing by emailing or sending a letter 5. If you have a bad feeling about how you are being treated, contact an attorney to discuss your rights

Each long term disability claim and plan is different. It’s important to understand the policy that governs your claim so you may follow its rules and know your rights.

If you are concerned your claim may be denied, or if your claim already has been denied, contact an experienced Hawks Quindel disability attorney to discuss your rights.

 

 

 

William Parsons

Shareholder at Hawks Quindel, S.C.
Bill practices as a long term disability lawyer and workers compensation attorney at the Madison office. His practice focuses on representing individuals with Wisconsin workers compensation claims, long term disability insurance claims, and unpaid wage disputes.