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Evidentiary Requirements for Proving Long-Term Disability

A long-term disability (LTD) policy covers a part of an employee’s income should they become incapacitated. Some employer’s offer LTD coverage as part of the employee benefits package. You may purchase one yourself if your employer does not offer it. Buying LTD insurance is the easy part. Making a claim, on the other hand, is another story. A person filing for an LTD claim will need to submit various medical evidence proving that he or she is indeed unable to work due to a disability.

Long-Term Disability Requirements

Before filing for an LTD claim, you first need to understand the policy’s exact definition of disability. You may consult with your employer’s HR department if it’s part of your benefits package. If not, check the summary plan description in your policy. As a general rule, total disability means you no longer have the capability to fulfill the responsibilities of your occupation. Partial disability, on the other hand, means you are still able to work, but on a limited capacity.

Just like with social security disability claims, your doctor will be asked to write in detail his or her opinion about your condition. Your physician’s official statement is vital in your application, but a claims administrator will also ask for supporting documents such as your complete medical records which may include any of the following that applies:

  • MRIs
  • CT Scans
  • EKGs
  • EMGs
  • X-rays
  • Blood Tests
  • EEG
  • Pulmonary Function Tests
  • Electrophysiological Tests
  • Psychological Tests

Take note that many policies will not grant your claim if you are still under your employer’s payroll.

Why Do Long-Term Disability Applications Get Denied?

Claims administrators may deny disability applications if:

  • You provide insufficient medical evidence
  • You fail to meet the LTD policy’s definition of disability
  • The video surveillance gathered by investigators show any inconsistencies with your claim

If your claim gets rejected, you are given time to appeal an initial denial. Take this time to hire a qualified and experienced LTD attorney who can help you gather all your medical records and other pertinent documents. If you miss the deadline, you also lose the chance to file a lawsuit against your insurance policy provider because you did not use your administrative appeals.

Filing for an LTD claim is not as straightforward as you may think. You need to understand the coverage of your insurance policy carefully. It could cost you a lot of trouble if you misunderstand any of the stipulations on it. Hiring an LTD attorney from Schiffman Law Office, P.C. in Phoenix can make the whole process a lot easier as they will gather and submit all the documents for you. They will also be the ones to deal directly with your insurer. Contact us today for a free consultation.

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