Long Term Disability Denial Letter from Insurer is Not the End of the Road

. By Brenda Craig

Many people on short term disability (STD) mistakenly think they will automatically be switched over to long term disability (LTD) providing their health condition hasn't changed.

Disability insurance is intended to help individuals through rough spots, providing them with income when health problems keep them off the job. However, insurance companies are big corporations concerned about their bottom line. Unless policy holders can stand up to the insurance company's strict requirements during the critical cross over period from short term disability to long term disability there is a risk the benefits will be denied.

Short Term Disability and Long Term Disability

Short term disability policies usually run from six weeks to six months. After that, a policy holder whose condition has not changed, will often expect that they will automatically be switched over to long term disability status and their benefits will continue.

But, moving from short term disability (STD) to long term disability (LTD) is not always smooth sailing.

The reality is many insurers take that change over period as an opportunity to review and deny future benefits. Disability lawyer Kristen Gyolai tells clients who receive a "claim denied letter" never to accept it as the end of the road. It's not.

"What people don't realize is that there are many more hoops to jump through after you have exhausted your short term disability policy," says Gyolai from Fields Law in Minneapolis, Minnesota.

Gyolai has been helping people deal with insurance companies and disability claims for close to two decades.

"Sometimes one insurance company handles short term disability policy benefits," she says. "Then when those benefits expire individuals suddenly find they are dealing with a completely different company for long term disability benefits with different requirements."

The Cross-Over Period

The cross over period from STD to LTD will very likely mean the new insurer will conduct an intensive review of the individual's health status. It is not unusual for clients to come to Gyolai's office after they have received a letter denying benefits.

"People think, 'my condition hasn't changed and this will just roll over into long term disability'. But, it is just too easy at that point for the insurance company to take a look at the situation - and deny the future benefits.

"This is a wide open opportunity for the disability carrier to say we just don't think there is sufficient proof that your condition prevents you from doing your job," says Gyolai. "Or we don't think there is objective testing to show you have functional limitations. They then deny the claim for those reasons even though the individual's condition is no different than when the individual was receiving STD benefits.

"Again," says Gyolai, "These are very likely two different insurance companies, with two different sets of requirements. Just because an individual met the definition of disability to qualify for short term disability policy doesn't mean they are automatically going to meet the definition of disability in a long term disability policy."

Never Take No for Answer

A letter from an insurer denying LTD benefits can be intimidating. Many people just give up and go away. Many don't realize they can appeal that decision.

Gyolai tells clients they have every right to fight back and should fight back hard.

"People give up on these benefits all the time. The insurer counts on that," she says. "That is the saddest part. People don't think it is worth the hassle to jump through the hoops to get the LTD benefits.

"We routinely step in at that point to help the individual appeal the decision that the long term disability carrier has made," she says. "I would say don't give up. Let us do the heavy lifting. Let us fight the insurance company. We know how to do it.

"The insurance company will hire a medical reviewer to look at our client medical records and give an opinion to say they are not disabled or they do not meet the definition of disability in the long term disability policy."

Gyolai's team works with their own doctors to rebut the opinions of the insurance company doctors.

"We will ask our doctors to give an explanation as to why he or she does or does not agree with the reviewers' conclusions. We will also enlist the help of a vocational expert to parse out what is required in the job the person is expected to perform and use the use the medical restrictions provided by our client's doctors to show that person is not capable of performing those job duties," she explains.

Denial Letter is Not the End of the Road

People who have been denied LTD claims have a right under ERISA laws (Employee Retirement Income Security Act) to appeal these decisions.

"Talk to an attorney about how you can appeal," says Gyolai, "Don't take the insurance company's denial letter as the end of the road. It is not!"

And if that doesn't work, if necessary, then there's always the option of filing a lawsuit against the insurer.

Denied Disability Insurance Legal Help

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