Long-Term Disability Insurance Attorneys (ERISA) in Florence, Alabama

You signed up for long-term disability insurance (LTD) at your place of employment, hoping you’d never have to use it, but now that you find yourself with a medical condition preventing you from working, your LTD insurer denies your claim.

If you find yourself in that predicament, you’re not alone, but fortunately, federal law allows you to appeal the decision, and with the help of a long-term disability attorney, you can increase your odds of having the denial reversed.

At R. Willson Jenkins PC, our attorneys have represented hundreds of individuals from all walks of life regarding their long-term disability appeals, including doctors, nurses, dentists, medical personnel, machinists, teachers, firemen, policemen, business owners, coaches, production workers, airline attendants, utility workers, maintenance personnel, and many others.

We know how the system works and are here to help. But don't delay, as you only have 180 days to appeal your long-term disability denial.

We'll work with you and your doctor to present the best information possible about you and your disability. We'll stand up to the insurance companies and fight back on your behalf in Florence, Alabama, and the neighboring communities of Tuscumbia, Sheffield, and Muscle Shoals, and throughout the U.S.

What Is Considered Long-Term Disability?

Insurers underwriting long-term disability policies use the definition of disability provided in the Social Security Act (SSA), which defines being disabled as “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

A study by the Council for Disability Awareness (CDA) surveyed which medical conditions generated the most claims for LTD benefits. The number-one most cited medical condition involved musculoskeletal/connective issues, such as arthritis, osteoporosis, fibromyalgia, or scoliosis. This was followed by:

• Cancer and neoplasms (breast cancer, prostate cancer, lymphoma, Hodgkin’s disease, leukemia, and tumors)

• Cardiovascular/circulatory conditions (heart disease, stroke, aneurysm)

• Injuries and poisoning (fractures, dislocations, contusions, burns, poisoning)

• Mental disorders (schizophrenia, bipolar disorder, anxiety)

• Complications of pregnancy, childbirth, and the puerperium (toxemia, ectopic pregnancy)

• Nervous system-related issues (multiple sclerosis, epilepsy, paralysis, dementia, Alzheimer’s)

• Symptoms, signs, and ill-defined (anorexia, sleep apnea, seasonal affective disorder)

• Digestive system diseases (pulmonary fibrosis, cystic fibrosis, COPD)

Filing a Long-Term Disability Claim

The first step in filing a claim is the one that, if skipped, often leads to a claim being denied: Seek the help of a long-term disability attorney. Your insurer may require various forms for you to fill out, which by their nature are designed to make denial easier. You might get two lines to define your medical condition when it is no doubt much more complicated than that space allows. Your attorney can help you with the required responses on the claims application and associated forms.

Along with your application and/or other forms required by the insurer, you should also obtain a detailed description of your disabling medical condition from your doctor, along with copies of any X-Rays or MRIs you’ve undertaken in the diagnosis of your condition.

You should also obtain statements from your family, coworkers, and friends concerning your condition. For example, your spouse can testify that he or she needs to get you in and out of bed, or help you bathe, or whatever your condition necessitates.

Common Reasons for Denial

By law, your insurer must inform you of the reason(s) you are being denied your LTD claim. Insurers have an endless number of reasons they cite, some legitimate, some not. The most common, however, relates to the supporting medical evidence you provided, or failed to provide. This is what insurers call insufficient medical evidence. You need to make sure you provide your complete medical records and evaluations, along with any X-Rays or MRIs supporting your claim.

Missing regular medical treatment is also a red flag for insurers. If, for instance, you’re suffering from depression or anxiety, the insurance company will investigate whether you’re visiting your primary care physician and appropriate specialists routinely. The same goes for physical conditions that require routine follow-ups and treatment.

Insurers have also been known to hire surveillance teams to take videos and photos of your day-to-day activities. Though they can’t enter your private residence without permission, they can film you while you are driving, shopping, dining, or doing anything in a public place. They may deny claims based on video or still photo evidence.

If Your Claim Is Denied

If your claim is denied, it’s not the end of the road. Policies covered by the Employee Retirement Income Security Act (ERISA) allow for two appeals, and if those still turn out unfavorably, you can file a lawsuit. Most employer-sponsored LTD plans are covered by ERISA, but there are a few exceptions.

Under ERISA regulations, you have only 180 days to file an appeal from the date you receive your denial letter. In general, you are required to file an appeal, possibly two, if you are denied long or short-term disability. If you fail to appeal or exhaust all administrative remedies, then you may be prevented from filing a lawsuit later on.

If both of your appeals are denied, your insurance plan determines how long you have to file a lawsuit. ERISA is silent on any statute of limitations, and your plan may give you only six months or a year in which to challenge any rejected appeals in court.

Generally, the lawsuit filing deadline information can be found in a document called your "Summary Plan Description" (SPD). The Summary Plan Description has to be supplied to you by the Plan Administrator, who is often your employer.