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What happens after a denied claim for long-term disability?

On Behalf of | May 31, 2023 | Long-Term Disability

Most adult professionals do not have much of a financial safety net. If they were to fall ill or suffer a serious injury, they may only have enough set aside to cover a few months of household expenses. Those who find themselves unable to work may also soon find themselves struggling to pay for housing and groceries.

Some employers offer long-term disability insurance benefits as a perk to provide greater stability for their workers. Many individuals who work as the primary wage earner in their families may purchase their own long-term disability coverage so that they know there will be wage replacement benefits available if/when they are unable to work.

Such policies are often the only protection someone has after a sudden medical emergency leaves them without income. Those who are filing a claim for long-term disability benefits often have no real alternatives, and some of them won’t get the benefits they expect when they apply. What happens after a denied benefits claim?

Applicants have the right to appeal

Those who pay for insurance coverage typically have certain rights under the law and other protections granted in their policy documents. Those who accepted jobs that provided them with long-term disability coverage as a work benefit have even greater protections thanks to the Employee Retirement Income Security Act (ERISA). Both ERISA-governed and private long-term disability policies will typically have an appeals process in place.

If applicants disagree with the decision made when they saw their benefits, they can appeal. Sometimes, what they need is to secure more medical documentation affirming the extent of their condition and how it limits their ability to work. Other times, the insurance provider may have knowingly rejected a valid claim, at which point the policyholder may need to consider a bad faith insurance lawsuit against the company.

Although pursuing an appeal can take a bit of time, it may be the best or possibly only means of someone securing the resources they need to support themselves and their dependent family members after suffering a medical condition that forces them to quit working. Reviewing policy paperwork and seeking legal guidance may help those who are deciding how to respond to a recently denied claim.