VA Disability Lawyers Explain Why Your Application Was Denied

If you are struggling to obtain benefits, our VA disability lawyers may be able to provide assistance. Employer-provided long-term disability (LTD) benefits and policies are determined by the federal Employee Retirement Income Security Act. ERISA dictates the requirements that disability applicants must meet and have evaluated by insurance company claim administrators. Because this presents a natural conflict of interest, it is common to have your claim denied even if it meets all ERISA guidelines. Claims administrators routinely deny applications for many different reasons, some of which are not valid. It is important to understand why your claim was denied so you can effectively appeal at the administrative level as well as in a federal court, if necessary. These are some of the most common reasons for claims denial.

Insufficient Medical Evidence

Supporting medical records are the key to successfully obtaining your LTD benefits. It is important to keep up with regular medical treatment that can document your illness or injury. Your insurer will be looking for regular visits to your primary care doctor as well as specialist visits when appropriate. For mental health claims, you should see a psychologist monthly at least. If you have a physical disability, you should have a variety of objective tests such as MRIs and CT scans.

Missing Medical Records

Even with a solid history of treatment, your claims may be denied if your insurer is unable to gather all your medical records. For this reason, your long term disability lawyer should make sure that the insurer has all relevant medical records to prevent unnecessary denial. Your disability lawyer in Cleveland may also have to make sure that your insurer requests the correct records as it may not be motivated to do so on its own.

Doctor’s Statements

The most important factor in showing your disability is the professional medical opinion of your treating physician. Your disability lawyer in Cleveland should request a detailed opinion from your doctor that discusses the various medical limitations that prevent you from returning to work. This letter should clearly present your impairment in terms of how it limits your ability to work.

The Definition of Disability

Your insurance policy may have a definition of disability that does not include your condition. You should consult your policy’s summary plan to determine if this is the case. Many LTD policies have an “own occupation” policy, which determines that you are disabled if you are no longer able to perform the duties of your job. “Any occupation” policies define disability as being unable to perform any job. You may be denied if your insurer decides that you are able to seek employment outside of your previous field. You should also check your policy’s summary plan description to see which conditions are excluded. Medical conditions that are related to substance abuse or a pre-existing condition are often not included in coverage plans. If you are dealing with a medical issue that is based on subjective complaints and is not able to be tested for through objected means, you may only receive 24 months of benefits.

Video Surveillance Inconsistencies

Many claimants do not realize that insurance companies can and frequently do perform video surveillance of applicants outside the home. If you are in the process of filing a claim for LTD benefits, it is essential that you do not perform any activities that are inconsistent with the limitations you stated in your application. Your claim could be denied and any previously award benefits could be terminated. Video recordings are often used to prove that you are not really disabled, even if this is not the case. For example, if you suffer from fibromyalgia and have more energy to carry in the groceries one day, your insurer may determine that you are not really disabled. While your disability lawyer in Cleveland can help you argue against a denied claim, it is best to be careful when you are applying for benefits. Always follow your doctor and avoid doing things that could be held against your claim.

Missed Deadlines

Missing a deadline is one of the most critical mistakes you can make when applying for LTD benefits. Most plans governed by ERISA give you 180 days to appeal a denial. You should not wait until this time has passed to hire a disability lawyer in Cleveland. It takes time to build evidence in your administrative record, and this paperwork is often delayed. If you miss the deadline, you will no longer be able to sue your insurer in federal court since you have not exhausted your administrative appeals. The filing deadline given upon notice of denial should be the beginning of your appeals process. You should also submit all of your medical information as soon as possible after the appeals process begins. ERISA laws limit courts to only considering evidence within the administrative record, so it is unwise to wait until you are present in federal court to present your records as they may not be considered. It also takes time to receive documents from your treating physician and specialists, so starting early gives you the time you may need to compensate for any delays in processing that occur. The sooner the insurance company receives your information, the sooner an ALJ can hear your appeal.

Contact Our VA Disability Lawyers

Call David M. Hicks today at (314) 812-4885 to work with VA disability lawyers you can trust to represent your claim.