Reasons for an LTD Claim Denial in Houston, TX
Employer-provided longterm disability insurance (LTD) provides millions of Americans with the financial security they need when an illness or injury keeps them from working for more than 90 days. For years, you may have been paying into your insurance policy, allocating substantial finances with the expectation that, if injured or suffering from an illness, the insurance provider will keep your finances, bills, and other matters afloat through timely payments.
Unfortunately, due to inherent conflicts of interest, there are many Houston-based insurance providers that routinely deny claims, even though qualifying evidence is objectively present. If your insurer, whether private or operating under the Employee Retirement Income Security Act (ERISA), has denied your LTD claim, it is essential to contact a Houston LTD attorney as soon as possible.
At Herren Law, we’ve encountered thousands of hard-working, honest citizens in Houston that have had their LTD claims denied for a myriad of reasons. You’ve been paying into LTD for years, and you rightfully deserve benefits if unable to work. By contacting Herren Law, we’ll diligently investigate your claim, policy, and the reasons as to why your insurance provider denied your application, and we’ll initiate an appeal immediately and guide you through the process. In the meantime, it can be helpful to understand why some providers deny LTD claims.
Most Common Reasons for an LTD Claim Denial in Texas
Being denied an LTD claim when unable to work can be a stressful situation, and in some cases, it encourages the applicant to lose hope for benefits. Although some insurance companies carefully sift through every detail of an application, searching for the smallest scapegoats for a claim denial, there are a few common reasons for LTD claim denials in Texas. Knowing these reasons can help you with your initial application, while also exposing the next steps for appeal.
Insufficient Medical Evidence is one of the most common reasons for a denial. The key to a successful application is including more supporting medical evidence than necessary. This should include documentation showing regular medical visits to your primary care physician or another specialist. Also, make sure to include a doctor’s statement explaining his/her medical opinion regarding how your disability has limited or negated your ability to work in your profession. Lastly, you should always contact your insurance carrier for a list of necessary medical records and double check that these records are present in your application.
Failure to Meet Policy’s Definition of Disability refers to your inability to work, the definition of disability outlined in your policy, and the coverage your policy provides. For example, an “own occupation” LTD policy only provides coverage if you’re medically unable to work in your occupation. An “any occupation” LTD policy provides coverage if you’re medically unable to work in any job. There may be other definitions or conditions in the policy summary plan, so make sure to closely examine this information.
Video Surveillance Inconsistent With Claim is a standard denial if your insurance company’s investigators have recorded that you were performing certain activities inconsistent with your disability. Keep in mind that investigators could be looking for this information whether you’re filing an LTD claim or receiving LTD benefits.
Missed Deadlines are notorious for LTD claim denials, and it is crucial to make sure that you file and appeal your claim within the set deadlines. ERISA plans generally give about 180 days to appeal after the initial denial. If you miss this deadline, for example, you might not be able to sue your insurance provider for “bad faith” practices in federal or state court.
How an LTD Disability Attorney Can Help
Having an experienced and aggressive LTD attorney is ideal before even filing a claim. In some cases, for example, the insurance company may ask you to submit information that it could later use against you or use for its own investigations. With Herren Law, we’ll ensure that every piece of information you submit with your initial application exceeds the recommendations from the insurance company, but we’ll also make sure that no pieces of documentation can be used against you later, whether in the appeals process or the courts.
If you’ve already been denied, however, we’ll immediately begin the motions for an appeal. With extensive experience and insider knowledge of ERISA law in Texas, Attorney William Herren will put your case in the best light through additional medical evidence as well as stronger opinions from your doctors and vocational experts. Expert testimony is often key in these cases, and Herren Law can use its widespread resources to get third-party opinion on your side.
Contact Herren Law Today
The most important thing to remember is to not give up hope. In fact, many insurance companies deny initial applications regardless of merit. With Herren Law, we’ll guide you through the entire process, from initial application to appeals, and if push comes to shove and your insurance provider is acting in bad faith, we’ll aggressively represent you and defend your rights and interests in court. Feel free to visit our Houston office at 6363 Woodway Drive, or you can contact us for a free consultation at (800) 529-7707. We are here to help you in your time of need. Therefore, you won’t owe us anything unless you receive your benefits.
