Long-Term Disability (LTD) Explained
by a Phoenix Attorney
Most workers are covered under the Social Security Act, and if a physical or mental impairment renders them unable to work they may apply for disability. Some Arizona workers are also covered under other systems. School teachers, city or county workers, Department of Public Safety workers and other public employees may have coverage through the Arizona State Retirement System or other public disability plans. Also, many workers have coverage through plans available through their employment, including plans established pursuant to the Employee Retirement Income Security Act of 1974 (ERISA).
These plans often require workers to file for Social Security Disability Insurance Benefits (SSDIB) and reduce the amount paid by all or a portion of the SSDIB benefit. With Schiffman Law Office, P.C., you can always count on our Phoenix long-term disability attorneys to explain the various plan requirements, exclusions and offsets and assist you in fully developing the evidence to support your claim.
The Basis for Denial in Long-Term Disability
Each claim is unique and each insurance company evaluates claims based upon its own plan’s provisions or law. An experienced Phoenix disability lawyer will tell you that some common reasons for denial include:
- The existence of a pre-existing medical condition;
- The medical record, including physician reports and test results, is inadequate or insufficient because it doesn’t address all of the important issues; or
- The claimant is not disabled within the requirements of the Plan.
Although insurance companies often have great discretion to deny a claim, a Phoenix disability attorney understands the requirements of the law and can help you in fully developing evidence that establishes a valid claim.
What is Bad Faith?
The essence of bad faith is when an insurance carrier engages in an intentionally dishonest act to avoid fulfilling its legal or contractual obligations, such as by violating basic standards of honesty in dealing with others. Some examples cited by Schiffman Law Office, P.C. include:
- Delaying making a payment indefinitely;
- Intentionally making policy language confusing or ambiguous; or
- Encouraging and perhaps rewarding claim adjusters for denials
When presenting a claim under a private plan, proof that the insurance carrier engaged in bad faith can result in the award of significant damages. Under ERISA no damages are recoverable for an insurance carrier acting in bad faith.
The Appeal Process with Long-Term Disability
The specific process of appeal depends on the type of claim presented. For claims presented under ERISA, the Plan must permit 180 days from receipt of the initial denial of a claim to present an appeal. Shorter appeal times are permissible for additional voluntary appeals. Other claims have different appeal times. As Alan Schiffman cautions, “it is essential to know the time limits to appeal and how to fully prepare the evidence for the appeal because judicial review is often limited to the administrative record.”
Contact a Phoenix Disability Lawyer for Legal Advice
Insurance company representatives are trained to know every avenue available to deny a claim. Protect your rights and level the playing field by hiring an experienced and knowledgeable counsel.