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What Goes Into Being Approved for Long-Term Disability Insurance

What Goes Into Being Approved for Long-Term Disability Insurance

If you’re considering filing a long-term disability insurance claim, the question weighing on your mind is probably: “Will I be approved for long-term disability insurance?” Unfortunately, there is no quick or simple answer to that question. Whether or not you get approved for long-term disability insurance will depend on what qualifies as a disability, the type of disability insurance policy you have, and how often you see your doctor. This blog will discuss what goes into being approved for long-term disability insurance and why it’s important that you visit your doctor regularly.

Factors That Make It Difficult to Get Approved

Getting approved for long-term disability insurance can be difficult for some individuals, and not everyone may be eligible. One of the biggest factors is one of the most basic, what your disability insurance policy defines as a disability. A disability insurance policy that provides benefits for a claimant who can’t perform their current job will be far more generous than one that provides benefits for a claimant that can’t perform any job. Other factors could be if the claimant has a pre-existing medical condition, works in a high-risk occupation, age, income, and a history of mental illness or substance abuse. Reading your long-term disability insurance policy carefully and consulting with a disability insurance attorney will help you prepare for these speed bumps and help you prove your disability.

What Kind of Insurance Policy Do You Have?

Disability insurance policies are either group or individual policies. Group disability policies, or ERISA policies, are generally provided by a claimant’s employer. Individual policies are purchased directly from a disability insurance company through an insurance agent. ERISA policies are far less expensive than individual policies and have stricter limits on coverage.

Under either ERISA or individual long-term disability policies, claimants who are denied benefits can sue the disability insurance carrier. But with an ERISA policy, before filing a disability insurance lawsuit, you’ll need to seek an administrative appeal – and once the appeal has been decided, any information that didn’t make it into the record can’t be considered in determining whether you’re entitled to disability benefits. With an individual disability insurance policy, you don’t need an administrative appeal. You can request a jury trial, and your claim will go through a less burdensome review.

Medical Treatment is Very Important in a Disability Claim 

Medical treatment is crucial in a disability claim because it provides objective evidence of the claimant’s condition, establishes the severity of the disability, and documents the limitations and restrictions imposed by the condition. Insurance companies require medical evidence to evaluate a claim and determine whether the claimant is eligible for benefits.

Without medical treatment, it can be difficult to prove the existence and extent of a disability, and the claimant’s credibility could be questioned. However, medical records can demonstrate that the claimant has sought treatment for their condition and has followed the prescribed treatment plan, strengthening the case for disability benefits.

A Claimant Has a Duty to Get Medical Treatment Every Month

Many disability insurance policies ask that you continue ongoing treatments until they are no longer beneficial as a condition of receiving benefits. Even if your disability insurance policy doesn’t specifically require ongoing treatment, maintaining regular appointments is still a good idea to help document your condition. Disability insurance carriers have a financial incentive to deny claims whenever they can, so seeing that you are not seeking medical treatment regularly helps the insurer argue that your disability isn’t serious or that you’re worsening your disability by not going to the doctor.

At Bonnici Law Group, we specialize in long-term disability claims and can assist you with getting approved or fighting a denied claim. Understanding group and individual disability claims can be complicated, but our skilled team can help you understand your policy and get you the benefits you deserve. Call us at (619) 259-5199, or click here for a free consultation! We’d love to work with you.

What Goes Into Being Approved for Long-Term Disability Insurance
1006, 2024

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