If your initial claim for long-term disability (LTD) benefits has been denied by your insurance company, you shouldn't give up.

Disability Insurance Claim

Disability Insurance Claim

When it comes to disability insurance, there are many differentiating insurance policies available. With such a variety of insurance policies comes a variety of ways that insurance companies can attempt to deny your disability insurance claim.

Insurance policies typically contain complicated language that the average policyholder may not easily interpret. Often, disability insurance policies contain terms such as “total” and “residual”. When your disability insurance policy language refers to a “total disability”, this typically entitles the policyholder to the maximum monthly benefit described within the policy. When your disability insurance policy language refers to a “residual disability”, this most often means that the policyholder is entitled to a disclosed percentage of the maximum monthly benefit described within the insurance policy.

Beware of insurance disability carriers who attempt to reduce the duration of your benefits. Some insurance policies depict benefits to be administered to a certain age (typically 65) while other insurance policies dictate benefits to be administered for life. Certain disability insurance policies will also cover expenses such as lost income and business overhead costs if the instance calls for it. These disability insurance policies are designed to assist business owners when disability occurs.

When filing a claim with your insurance company, there is much to navigate, including but not limited to: claimant statement forms, medical examinations, physician statements, medical records, field interviews and more. Throughout the claim process with your insurance company, many factors can come into play. The attorneys at the Merlin Law Group are well rehearsed in these type of insurance claims and can assist you in maximizing your claim approval.

Once you have received approval for your disability insurance claim, you are still not done dealing with your insurance company. Your insurance company will continue to monitor you throughout your disability insurance disbursement of payments. Whether through periodical medical examinations, the continuing of claimant statement forms or more, the insurance company will continue to evaluate your disability as long as they are covering you for it. Even the post-claim approval road can be a bumpy one. The attorneys at the Merlin Law Group are experienced in navigating the insurance claim process and can work towards maximizing your benefits without litigation.

The Importance of an Own Occupation Policy

There are different kinds of disability insurance and it is important to know which one you should be purchasing. There are many different factors that go into the decision but an important differentiation is own occupation and any occupation. Own occupation disability insurance is preferred because it will compensate that salary you would be receiving with your occupation. If you were a surgeon and suddenly lost your hand and could not perform the profession anymore, you would not want to be told that you could be a greeter at a grocery store because you are able to do that with your disability. You would want to be compensated for the salary you would be receiving as a surgeon.

Own occupation disability insurance coverage would classify you as disabled because while you could sit and cash people out at a store, you can no longer perform the job you were an expert in and potentially invested in education for. Any occupation would not count you as disabled because there are certain jobs you can still perform. Own occupation disability insurance coverage will allow you to receive the income you were earning before you were disabled. While there are ways Merlin Law Group can help you if you have any occupation disability insurance, it is smart to purchase own occupation to avoid troubles if you were to become disabled and not be able to perform your job anymore.

A second distinction to be aware of when it comes to buying disability insurance is the lifetime or age of 65 policies. Many disability insurance policies will try to cut you off at the age of 65. There are policies that will cover the salary you missed out on because of your disability throughout the rest of your life. Permitting it doesn’t cost an unreasonable amount, this is the better option.

Denial Based on a Lack of Routine Care

A common basis for disability claim denial is a lack of routine care by a physician appropriate for treating the kind of disability you are claiming. This is a subjective form of denial because many times disabilities can be a chronic problem where it isn’t necessary to visit a physician on a weekly basis for them to tell you what is wrong and that all they can do to help you is advise stretching and medication.

Insurance companies will state in their disability insurance policies what it means to receive routine care but the definition can be ambiguous and subject to various interpretation. Merlin Law Group’s attorneys can help you with this angle if your insurance company denies your claim on this basis of lacking routine care.

As a policyholder, you can visit your physician relatively frequently to what you see necessary. Also make sure your physician is adequately documenting their medical records to make it clear that you are only needing to visit them as frequently as you are. They can state that there isn’t a reason for you to be visiting the physician any more frequently than you are. A well-documented medical record is valuable. While you can’t force your physician into stating anything that isn’t true about how often you visited, you can stress the importance to you in keeping the records accurate and well documented.

If you experience any problems with your disability insurance claims, or any insurance claims, do not hesitate to contact Merlin Law Group. The intake analysis is always a courtesy.


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