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Four Common Types of Long-Term Disability Denials

For those who suffer from a serious medical condition, such as a catastrophic injury or a life-threatening illness, long-term disability insurance can be a blessing – that is, if the insurance carrier pays when it is supposed to. Sadly, many large disability insurance companies have a tendency to look for clever ways to avoid paying otherwise perfectly valid claims. While this may cut a few dollars off of the company’s bottom line each year, it can devastate a deserving family who desperately depends on those funds for survival.

At Burke Harvey, LLC, our long-term disability insurance lawyers are here to make sure you and your family are treated fairly and that you receive all of the money to which you are entitled. Call us today to schedule a free consultation with one of our attorneys, and let us review your situation to see if we can help.

Among the many ways that insurance companies unfairly deny claims, here are just four of the most common:

Making Partial Payments Instead of Full Payments

A long-term disability policy could arguably be called an income replacement insurance policy. It is designed to replace a portion of your income while you are out of work due to a qualifying condition. For instance, your policy may provide for 70% of your regular salary, and it may have a 30-day waiting period. This means you must first show that your medical condition is so serious that it requires you to be out of work for more than 30 days, and such a policy will then begin paying on Day 31.

This is where some insurance carriers scam their policyholders. Some may start making payments, then quickly cut payments to a lesser amount, based on confusing or misleading policy provisions that reduce benefits. Other companies may stop payments altogether, arguing that the medical condition did not meet their guidelines, even after beginning payments. This can create a sort of reliance, where the disabled individual starts depending on the benefits for regular bills and support, only to have the benefits stripped months down the road. 

Not Disclosing Benefits

Many states have outlawed the practice of concealing benefits from policyholders, but insurance companies still do it. One of the oldest tricks in the insurance company playbook is to outright mislead consumers by not telling them the whole truth about their coverages.

For instance, you may have both a short-term and long-term policy through your employer. The long-term policy is, in most cases, designed to dovetail nicely with the short-term policy so that the long-term coverage is triggered once the short-term coverage runs out. This way there is no overlap or duplication in payments. An insurance carrier may tell you that you have a lengthy waiting period but fail to mention your rights under your short-term coverage, which is often underwritten by the same company. Likewise, some carriers will also lie about the number of your benefits or what you must provide in order to obtain your benefits.

Mislabeling Diagnoses

Perhaps one of the most surreptitious maneuvers employed by the long-term disability insurance industry is to mislabel or incorrectly characterize a medical diagnosis in order to trigger an automatic denial.

Insurance companies use diagnostic codes to properly outline and categorize the assortment of potential health conditions that could make one eligible for benefits. These diagnostic codes help insurance companies (and their computer databases) sort out the difference between rotator cuff tendonitis and a rotator cuff tear that requires surgery or a benign tumor from a life-threatening one. By intentionally mislabeling a condition, an insurance company can trigger a denial that deprives a deserving person of the benefits.

Technical Terminations and Delays

In addition to all of these unscrupulous tactics, insurance companies also frequently deploy simply bureaucracy as a strategic maneuver for avoiding payment. By dragging their feet, they can leave people so hopeless that they give up or miss appeal deadlines. This can lead to technical policy terminations or technical denials.

What to do About Improper Disability Insurance Denials in Alabama

It is important to understand that both state and federal laws exist to protect disabled workers and their rights to long-term disability insurance benefits. After all, if you have one of these policies, it is because you have paid into the program and purchased those benefits.

As the Alabama Supreme Court held in National Security Fire & Casualty Co. v. Bowen, you may be able to bring a lawsuit against the insurance company for “bad faith,” alleging that they intentionally or unreasonably denied your benefits. To succeed, Alabama courts have held that you must prove:

  • There was a contract and the insurance company breached it
  • The insurance company’s denial was intentional
  • There was no reasonable basis for the denial
  • The insurance company knew there was no reasonable basis for the denial

If you have been unreasonably or unfairly denied long-term disability benefits, call the attorneys of Burke Harvey, LLC today. We never charge upfront fees or costs to get started, and we only get paid if we are successful in recovering the benefits to which you are rightfully entitled. So call us now to learn more or to schedule a free case evaluation.

Does My Condition Make Me Eligible for Long-Term Disability Insurance?

It is not uncommon for someone dealing with a serious health concern to worry about qualifying for disability benefits. Most people rarely give a second thought to these things until they are actually faced with a severe medical complication. Whether it is an unexpected injury or a deteriorating chronic condition, the fact is that it is common to worry about how you will feed your family, how you will keep your home or apartment, and how you will survive without income.

This then leads to a second and often troubling question: Does my condition qualify me for benefits? After all, just being sick or injured does not necessarily entitle one to benefits from a long-term insurance policy. As a preliminary matter, the best way to find out if your particular diagnosis entitles you to benefits is to speak with a long-term disability lawyer right here in Birmingham, Alabama.

At Burke Harvey, LLC, our attorneys have years of practical experience guiding disabled workers and their families through some of the toughest times in their lives. If you are facing a disability, give us a call today.

What is a Disabling Condition?

The vast majority of long-term disability insurance policies are governed by the federal law, ERISA (Employee Retirement Security Act). That law generally gives insurance companies the right to define a disabling condition contractually in the insurance policy. However, as a general rule of thumb, a disabling condition is a mental, physical or emotional condition that renders you unable to work. Likewise, in most cases, the condition must be expected to last more than a year or be likely to cause your death within two years or less.

Understanding How a Condition Affects One’s Ability to Work

So, what exactly does this mean for people who have chronic diseases or serious injuries? Who exactly decides if you can work or not? This is the source of much dispute. For instance, a person may have a bad back but still be able to keep working in a sedentary office job, so long as the employer makes reasonable accommodations for frequent breaks and there is no heavy lifting involved. Even things like paralysis may not entirely make work impossible. It all depends on the individual who is suffering from the condition.

This is why long-term disability can get complicated. Consider the example of a manual laborer who has spent 15 years in a trade. A serious back injury could qualify the worker for long-term disability because his physician would likely find that it is impossible for him to continue performing the set of skills and tasks for which he is trained. Absent other job skills, a long-term disability claim may be warranted.

Take the same back injury for an office worker, and it may have very little impact on his ability to keep working. Therefore, a disability claim may not be warranted for that worker, even though both have the same medical diagnosis.

Medical Conditions That May Qualify You for Long-Term Disability

According to Social Security guidelines, you can find information about many medical conditions online. Below are some of the more common conditions that lead to long-term disability. Just keep in mind that it is important to work with a physician who not only can diagnose the problem but who can also clarify why the condition impacts your ability to work:

  • Anxiety disorders
  • Bipolar disorder
  • Panic attacks
  • Spinal injuries
  • Back injuries
  • Traumatic brain injuries
  • Various types of cancer
  • Cerebral palsy
  • Epilepsy and other seizure disorders
  • Heart conditions
  • Leukemia
  • Obesity
  • Multiple sclerosis
  • Osteoarthritis
  • Parkinson’s disease
  • Post-traumatic stress disorder
  • Respiratory diseases
  • Stroke

Does a Long-Term Disability Policy Use the Same Criterion as SSDI?

Not necessarily, but they may be similar. The federal government sets forth the rules for qualifying for Social Security Disability (SSD). While the insurance policies may at times mirror SSD guidelines, it is important to understand that your long-term disability benefits are a private insurance benefit payable under a contractual insurance policy. Therefore, there are usually going to be distinct differences in how terms are defined and how you must qualify.

One thing both have in common is the need to prove your medical condition. It is never enough to simply claim to have a medical condition or allege that it keeps you from working. Instead, you will need competent and clear medical evidence establishing not only your condition but also demonstrating why that condition directly limits your ability to pursue gainful employment. This is often where a skilled long-term disability lawyer can be a tremendous asset.

Contact an Alabama Long-Term Disability Lawyer Today

At Burke Harvey, LLC, our attorneys are devoted to helping obtain the benefits that you deserve. If your insurance company has improperly denied your claim for benefits, we may even be able to step in and help launch a rapid appeal. In other cases, we may need to sue your insurance company to force them to honor their legal obligations. Just keep in mind that time is limited, so you need to take action fast. Call our firm to discuss your case right away.