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Understanding Long Term Disability Denials in New York

Understanding Long Term Disability Denials in New York

Long term disability insurance provides the income you need to pay your bills and living expenses if you are out of work because of an illness or accidental injury. However, many claims for long term disability are denied. Some denials may be reasonable, but many denials are not valid. A New York disability claims lawyer can review your case and help you appeal a denial of benefits so that you can receive the disability income you need while out of work.

Reasons Why Companies Deny Claims for Long-Term Disability

An insurance provider may deny a disability claim for a variety of reasons. However, a few common reasons seem to apply in many cases. Some of the reasons why an insurance company may deny a claim for long-term disability benefits include:

  • Failing to File by the Deadline — In most cases, private policies have strict deadlines for filing claims. Filing a claim after the deadline could result in a denial of the claim. There are also deadlines to file appeals of denials. ERISA governed plans have a 180-day period for filing appeals of denials. You need to check your long-term disability insurance policy for deadlines that may apply at various stages of your claim.
  • Providing Insufficient Medical Evidence — You must provide medical evidence that proves your claim for long-term disability benefits. If you are missing records or the information in the medical records do not substantiate a claim that you are unable to work, the company may deny your claim.
  • Failing to Meet the Definition of Disability — Your condition does not meet or exceed the narrow definition of disability contained in the long-term disability insurance policy. The definition of disabled may also change after a certain period. For example, to qualify for benefits, it may be necessary to prove that you are unable to carry out the duties required of your employment. However, if you are disabled for over a year or more, you may need to prove that you cannot perform any type of work to continue receiving disability benefits.
  • Evidence that Contradicts Your Claim of Disability — In some cases, an insurance provider may attempt to obtain evidence that proves you can perform activities that would allow you to work. The insurance company may hire an investigator to dig deep into your life to determine if you are honest about your limitations. Therefore, you should always follow the restrictions on activity provided by your physicians very closely.
  • Failing to Meet Filing Requirements — An insurance provider has strict filing requirements. If you do not adhere to the filing requirements, your disability claim could be denied on a technicality.

Appealing a Long-Term Disability Denial in New York

If you receive a denial notice of your claim for long-term disability benefits, you need to act quickly to preserve your right to appeal the decision. Read the notice carefully to determine the reasons or the denial of your long-term disability claim. You may need to submit additional medical records, or your employer may need to provide additional documentation or information to the insurance company.

Inquire whether you need to submit your appeal on a specific form or if a letter stating you appeal the decision is adequate. You must file your appeal before the deadline for appeals expires. A deadline to file an appeal could be as short as 60 days after the denial. While you are appealing the decision, continue to seek medical treatment. If you stop medical treatment, the insurance provider can use that fact against you when considering your appeal.

Contact a New York Disability Attorney for Help

Filing or appealing a long-term disability claim can be difficult. You need the benefits as quickly as possible. A New York disability attorney can help you file your claim or your appeal. Contact our New York SSDI lawyers today to discuss your situation. Because our attorneys are familiar with the process, we can help you avoid some of the mistakes or errors that often lead to a denial of a long-term disability claim.

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