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To obtain long term disability (LTD) benefits, you must persuade the insurer that you meet the standard of disability in your policy or plan. Typically, you must prove that you cannot perform the material duties of your regular occupation. The insurer will rely heavily on your application and supporting materials to make its decision. A thorough, timely application significantly increases your chances of success.
Here are some common mistakes that applicants make when applying for long-term disability benefits. You can avoid these all-too-common errors by getting help from the experienced New York long term disability attorneys at Riemer Hess. Don’t wait until your administrative appeal is denied to retain a lawyer. By then it could be too late. Any evidence not submitted during the administrative process generally is not admissible in future litigation.
Missing deadlines
Most LTD policies require a claimant to submit a Notice of Claim within 20 or 30 days from the Date of Disability. The Notice of Claim informs the insurer that you intend to submit a claim. The insurer will then send you the claim forms. These forms usually must be completed and returned to the insurer within 90 days from the end of your “Elimination Period.” The “Elimination Period” is the waiting period from the Date of Disability to the first date on which you are entitled to benefits. In most policies, the Elimination Period is 180 days, but sometimes it is 90 days or some lesser period. For example, if the Elimination period is 180 days, you must submit Proof of Claim no later than 270 days from the Date of Disability.
Using only the insurance company’s forms to describe your disability
Insurance company claim forms can easily trick you into providing an inadequate description of your disability. They are designed for the insurer’s benefit, not yours. The forms provide very little room for you to write. They must be supplemented with additional attachments and exhibits to provide a comprehensive explanation of your disability. Our New York long term disability attorneys know what riders and exhibits need to be submitted with your application and will make sure they are included.
Failing to tell a persuasive story of why you are disabled
Your LTD insurer wants to know why you could work one day and could no longer work a day later. If you can still drive, shop, and do other activities of daily life, but cannot do the “Material Duties” of your job, your insurer needs an explanation. If you have a condition that does not disable most people, you need to explain why it has disabled you. The narrative that you attach to the insurance company’s forms must answer these questions and more. It needs to provide a detailed description of the material duties of your occupation and why you can no longer do them. At Riemer Hess, we will help you craft an effective disability narrative that presents your claim in the most sympathetic light.
Not supporting your claim with sufficient medical evidence
A successful claim for long term disability benefits requires a package of supporting medical evidence. A simple note from your doctor that you are disabled is insufficient. You need to submit your complete medical history and records. Insurance companies demand objective evidence when you have a disability that can be established by it. Objective evidence consists of test results, such as MRIs, X-rays, blood tests, etc., and your doctor’s clinical observations. Many claimants have not had all the tests they need to prove their disability because the testing wasn’t necessary for treatment. Our New York long term disability attorneys will gather your medical records and submit them to your insurer. We will identify any additional testing you may need and help you arrange for it.
Not obtaining a helpful report from your doctor
A written opinion from your doctor is an essential addition to your application materials. Your insurance company will ask your doctor to complete a form, but the form often does not provide enough information. Moreover, doctors don’t understand disability insurance. Without guidance, sometimes the answers they provide can hurt your claim more than help it. What you really need is a written report that fully explains why your doctor arrived at your diagnosis, and why the medical signs and findings caused the doctor to conclude you cannot work. Our New York long term disability attorneys can give your doctor guidelines for writing the report or a form to complete that elicits the information the insurer wants.
Not providing enough evidence to support your claims of pain
Pain is perhaps the most common reason people can no longer work. It’s especially hard to convince an insurance company that you have disabling pain because there is no way to measure how much pain you are in. To prove your claims of pain you will need corroborating evidence such as doctor’s treatment notes; a functional capacity evaluation by a psychiatrist or physical therapist; an evaluation from a vocational expert; or statements from co-workers describing your struggles at work.
Not providing the insurer with sufficient vocational evidence
If you can meet your occupation’s exertion demands (i.e., sitting, standing, lifting), your insurer is likely to decide you are not disabled. However, your occupation probably has other significant demands, such as travel, a fast pace, long hours, or stressful deadlines that prevent you from working at it. If this is the case, your claim material must include vocational documentation such as a detailed description of the duties of your current occupation, your education and work history, and, in some cases, an evaluation by a vocational expert. Our New York long term disability attorneys will help you provide these materials to educate your employer on the true demands of your occupation.
Not providing persuasive evidence of your cognitive impairments
The cognitive demands of an occupation can be some of the most important for establishing disability. If your occupation requires a high level of intellectual ability, quick thinking, or keen judgment, you could be disabled with just a slight decline in mental processing speed. You may function very well in day-to-day activities, but not in a profession like surgeon, trial attorney, or high level executive. To prove your cognitive impairment, you may need neuropsychological testing or a SPECT brain scan.
Not making your claim come alive
You want the insurance company (and ultimately the court if your claim must be appealed) to see you as a human being. An affidavit from you describing your work, your medical condition, and how it has affected you can be compelling. If your disability is visible, a video of you can be very effective. By enabling the court to visualize what happened to you, you will have a greater chance that the insurer will grant your claim in the first place. Our New York long term disability attorneys have helped many claimants prepare detailed affidavits and moving video statements.
Seek Assistance From New York Long term Disability Attorneys
Prevent these fatal mistakes and get it right the first time. Call Riemer Hess LLC before you apply for disability benefits, or, better yet, before you even stop working. To arrange a consultation, call 212-297-0700.
