What are Effective Ways to Overturn a Denied Long Term Disability Claim?

At Bartolic Law, we understand the frustration and stress that accompany the denial of a long-term disability (LTD) claim. After all, long-term disability benefits are meant to provide financial stability during times when serious health conditions make work impossible. With decades of experience handling LTD claims, appeals, and litigation, we have helped countless clients turn denials into approved payments. Below, we outline effective strategies to challenge a denied LTD claim and increase your chances of a successful appeal.

Understanding Common Reasons for LTD Claim Denials

Insurance companies often rely on a variety of reasons to deny long-term disability claims. Common issues include:

• Insufficient medical evidence: Claims are frequently denied due to a lack of updated medical records, insufficient documentation of functional limitations, or gaps in treatment history.
• Pre-existing condition exclusions: Insurers may deny claims based on conditions they allege existed before coverage began, even if unrelated to your disability.
• Failure to meet the policy’s definition of disability: Many policies differentiate between “own occupation” and “any occupation” standards, leading to disputes about whether someone truly qualifies as disabled under the terms.

Understanding why your claim was denied is the first step in effectively addressing the issue.

Key Steps to Challenge a Claim Denial

1. Review Your Denial Letter in Detail  – Insurers are required to provide a written explanation of claim denials. Carefully read this letter to identify why your claim was denied and what evidence may be missing.
2. Compile Strong Medical Evidence   – A successful disability claim depends on comprehensive medical support. Gather all relevant medical records, diagnostic test results, treatment notes, and statements from your treating physicians. It is particularly important to ask doctors for detailed explanations of your limitations, focusing on how they align with the policy’s standards.
3. Understand Your Policy Language – Long-term disability policies often contain complex provisions. Knowing how your policy defines disability, exclusions, and deadlines for appeals is critical. Misunderstanding these terms can lead to overlooked opportunities to strengthen your case.
4. Obtain Expert Opinions – Some cases require additional expert opinions to substantiate the claim. Vocational experts, for instance, can explain how your limitations affect your ability to perform work duties. Independent medical evaluations may also counter claims that your condition lacks objective evidence.
5. Build a Comprehensive Appeal – The pre-litigation appeal is your only chance to present all evidence to the insurance company. This includes submitting additional documentation, addressing reasons for denial, and framing your case in a clear, persuasive manner. Visual aids, such as videos or photos showcasing the impact of your condition, can further humanize your claim.
6. Seek Legal Assistance – Insurance companies rely on experienced claims managers and legal teams to justify denials. Partnering with an attorney who understands ERISA regulations and LTD policies levels the playing field. At Bartolic Law, we help identify gaps in insurers’ reasoning, highlight favorable evidence, and negotiate with insurers to get claims paid before litigation becomes necessary.

Contact Us

Don’t face the challenges of overturning an LTD denial alone. By choosing experienced legal advocates like Bartolic Law, you gain a strategic partner committed to securing the benefits you deserve. Contact us today for a consultation. We’re here to help you turn denials into payments.