In our years of experience in representing claimants seeking long-term disability benefits, we have compiled a list of mistakes that claimants can make which can result in a benefit denial.  We would like to share that list with others who may be contemplating the need to file a claim for disability benefits:

1. Waiting Too Long or Filing Too Early 

If a claimant who has a disability waits too long to file and is fired from their job due to performance issues, it can create problems with pursuing a successful disability claim.  Remaining employed for too long potentially raises questions about whether the disability was the cause of job termination.  Conversely, if an employee files for disability immediately after receiving a diagnosis, it can also be problematic.  A diagnosis alone is almost never disabling.  It is not until the disabling condition causes functional limitations that a “disability” exists.

2. Filing a Claim Without First Securing the Treating Doctor’s Support

 It is critical to make sure that a disability claimant knows they have the support of their treating doctor before filing a claim.  Otherwise, a report from the doctor that fails to provide sufficient evidence of disability will likely torpedo a disability claim.

3. Failing to Discuss the Claim with the Treating Doctor Before Filing 

The doctor needs to have an understanding of the claimant’s occupation and why the claimant believes they are disabled before the doctor is able to submit a thorough and accurate report that is specific to the occupation in question.  Some conditions may have no impact at all upon some occupations but can be job-killing in others.

4. Failing to Obtain Examinations and Testing Recommended by the Treating Doctor 

Many disabling conditions have “gold standard” testing associated with those illnesses.  Failure to obtain such tests may undermine a disability claim because the insurance company is looking for such testing in deciding whether a claim approval is warranted.

5. Not Understanding the Disability Insurance Coverage

There is no such thing as a “standard” disability insurance policy.  Disability insurance coverage can be occupation-specific or be available only if the insured is completely unable to work.  There are also vast differences between individual and group disability benefits.  Consulting with an experienced and knowledgeable attorney in order to better understand the coverage before filing a claim is always a good idea.

6. Giving Up When you Receive a Denial

The insurance company expects that a significant number of people whose benefits are denied will simply give up and not challenge a denial.  A claimant who believes he or she is legitimately disabled should not take no for an answer and should consult with an attorney.

7. Not Hiring an Experienced Attorney to Handle a Claim Appeal 

This is probably the biggest mistake a claimant may make.  Disability claim appeals are complex, and most people have no idea how to handle an appeal on their own.  Hiring an experienced and knowledgeable attorney to handle an appeal is critical.  No one should wait to hire an attorney until after appeals are exhausted because it may preclude the attorney from introducing additional evidence in court.  If the claim is based on an employer-sponsored policy and is subject to the Employee Retirement Income Security Act (ERISA), it is especially important to get an attorney involved immediately after receiving a denial.  

8. Missing Claim Filing Deadlines

Deadlines are for real and they are usually inflexible.  The consequence of a failure to meet a deadline for submitting a claim or a claim appeal is that the claim may never be considered, no matter how meritorious.

9. Not Being Aware of Other Potential Benefits 

if a claimant becomes disabled, disability insurance may not be the only benefit they can receive.  Many life insurance policies contain provisions that continue coverage under a waiver of premium due to disability.  In addition, many deferred compensation types of employee benefit plans accelerate benefit payments on account of disability.  Although Social Security disability benefit payments may reduce the payments available from an insurance company, there are other advantages to receiving Social Security such as early Medicare availability; and a concurrent application for Social Security disability should also be filed.  A knowledgeable and experienced attorney can assist in helping identify other sources of benefits.

10. Thinking that You Are Limited to Applying for Benefits for Only One Condition

Many individuals who experience disability have more than one impairing condition.  Any medical condition that is a factor in causing disability should be listed in the application for benefits or a claim may mistakenly be denied.  

All of these mistakes are avoidable.  When contemplating filing a claim for disability insurance benefits, it is advisable to enlist the support of an experienced and knowledgeable attorney as soon as possible; and if the disability insurance is provided through an employer, finding an attorney who knows ERISA and who has an established track record of success will prevent a claimant from making the mistakes discussed above. 

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Update on ERISA-governed insurance benefit claims:  NACLE

Update on ERISA-governed insurance benefit claims: NACLE

ERISA law is constantly changing; and with each new ruling, the scope and context of how issues relating to disability, life and health benefits are resolved by the courts is constantly evolving.  In June of 2021, Mark DeBofsky recorded a continuing legal education program for the National Academy of Continuing Legal Education (NACLE) providing an update on ERISA-governed insurance claims.