How to Fix an LTD Claim – Top 5 Reasons for LTD Claim Denials | Andalman & Flynn Law Firm
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How to Fix an LTD Claim – Top 5 Reasons for LTD Claim Denials

Oct 13, 2020 | Long Term Disability

By Peter Casciano, Esq., 301.563.6685

  1. Your Doctor Failed to Fill out the Required Form – It is very common for treating physicians to resist completing your LTD form required for your application. The forms can be tricky, time consuming and there is often a lot at stake. “I don’t complete those kinds of forms” is a common phrase our clients report hearing from their doctors. Obtaining the required forms from your physicians while your claim is still pending on initial is obviously the preferred option. However, it’s also sometimes valuable on appeal as well, especially if your treating physician never filled out the insurance form in the first place. Fixing this “administrative” error can be difficult. Working with the physicians in order to obtain the form requires a sensitive but firm approach, especially so as not to interfere with the doctor-patient relationship.
  2. You Did Not Meet the Definition of Disability – There are many different definitions of disability. Some require that you are disabled from your own job. Some, your own occupation. Other, all occupations. Furthermore, there may be a distinction made between proving you are disabled from the key job duties, every job duty, or most job duties. Finally, if that wasn’t confusing enough, the definition of disability may be modified with an income threshold. A common income threshold says that you need to prove you are disabled from all occupations paying you 60% or more of your pre-disability income. Obviously, you need to review your policy for YOUR definition of disability. Then you need to find the position description applicable to you and/or the Employer insurance form completed regarding you before you can know if you meet the correct definition of disability.
  3. Poor Interview – Carriers often want to get you on the phone and ask you questions after you file your claim. In this space, there is no true record of your responses and the carrier can sometimes misconstrue or simply misunderstand your responses. This fact, combined with the fact that your disability might further impede your ability to express yourself, makes for the interview to be especially dangerous to LTD claims. If the carrier insists on a verbal interview, I strongly suggest hiring a lawyer by that point if you don’t already have one. A lawyer can help to make sure the carrier mind’s its p’s and q’s, while also making sure your answers don’t get twisted or taken out of context.
  4. Social Media – Information on social media accounts are often two things: aspirational and out of date. The way we describe ourselves online is often a bit inflated and dare-I-say boastful. Because of this, the carrier often has a lot of fodder to use against us if we are trying to prove our medical inability to function at work. Second, how often do we update our Linked-In page? Facebook? There could be old and very misleading information. I routinely have to do damage control because of out of date job application requests posted online that the carrier got a hold of, making it look like not only was my client not disabled, but he was actively applying for jobs. Two common tips: make your accounts private using the most strict settings and don’t accept “friend requests” from strangers.
  5. Trying To a Do a Little Work – Not every disability restricts clients from all work related activity. In some situations, claimants are restricted to part-time work or light duty work. If you are considering maintaining some level of work AND filing a disability claim, it’s imperative that you speak with an experienced disability benefits attorney. Any work could jeopardize your disability claim, depending on your doctor’s restrictions, your definition of disability, and the job you do.
  6. Failing to Meet the Carrier’s Requests for Documents – Too many times I have heard from clients and potential clients that they refused to send in documents because they “knew” the carrier already had them. This stubbornness could cost you your claim. I see no harm in re-filing supportive evidence. Maybe the carrier lost it. Maybe you transposed the numbers on the mailing address. Maybe the carrier is flat out lying. The bottom line is that refusing to re-send supportive information does nothing but potentially hurt you. Side note, don’t rely on the medical office to send in the information either. It’s not their job to be your admin assistant. I recommend you obtain copies of all relevant documents and you send them in so that (1) you have your own solid copy of what the carrier has, and (2) you can ensure the information was submitted correctly.
  7. Failure to File for Social Security Disability – Most LTD policies require that when you file for LTD, you also file for SSD. By filing for SSD, it may end up generating helpful information for your LTD claim. By not filing for SSD when required, it may signal to the carrier you aren’t serious about your disability. Lastly, if your policy does in fact require that you file for SSD, the carrier is usually able to deduct what it owes you after an approved LTD claim based on what they think you might receive from SSA. Don’t allow them to reduce your LTD benefit simply because you don’t want to go to SSA.gov and file your social security disability application.

These are only a few errors that could occur when filing an LTD claim. Please be careful and consider contacting me if you have questions about these issues or other concerns related to long term disability claims. Please feel free to call me at 301.563.6685 for a free consultation regarding your Long Term Disability claim.

About Andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & Flynn has forged a distinguished reputation for legal excellence. The firm represents individuals seeking disability benefits throughout the country and practices family law throughout Maryland and the District of Columbia. The firm focuses on cases that impact the rights of everyone, and are there for clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and their attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. For more information about Andalman & Flynn, please visit the website at https://andalmanflynn.com/ or call 301.563.6685.


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