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One of the biggest mistakes people make with Long Term Disability Claims is thinking that the LTD claims process is similar to health insurance claims - loaded with annoying paperwork, but something a reasonably intelligent person can handle. 

Unfortunately, managing a disability claim is not a simple process. Long Term Disability insurance companies often take advantage of an unrepresented claimant - and the claim will get denied, delayed, terminated or negatively impacted. Here are some common examples of why it is wise to start working with an experienced and aggressive Long Term Disability Insurance law partner from the beginning of the process:

Defining Occupational Duties

Long Term Disability insurance policy owner submits a claim form or gives an interview to the insurer without fully understanding the significance of the statements made. The insurance company utilizes these admissions as reasons for denying claim.

Question from Insurance Company: What are all of the activities you perform at your job?

Policy owner's Answer: As a dentist, I perform chair dentistry, and I sometimes assist the other dentists in their procedures, and submit insurance claims and pay bills.

Problem: The insurer now deems this disabled dentist residually or partially disabled, because he/she can perform administrative functions as well as act as a "dental assistant."

At Frankel & Newfield, P.C., a partner will guide you through the Long Term Disability claims process, so that the insurer does not determine your occupational duties, we do.  This prepares your administrative file if and when the insurance company decides to take an "own occupation/any occupation" tactic with a denial.

Improperly Prepared Medical Forms

What your Attending Physician puts down on insurance forms can lead to serious problems when the forms are reviewed with an eye to denying or delaying a claim.  When your doctor completes a claim form without fully understanding the definition of disability as contained in the Long Term Disability insurance policy, your economic future is at risk.  The insurance company utilizes this information to deny the claim, backed by what seems to be plausible rationales from your own physician.  Think about how difficult it is to challenge a denied or terminated claim when the insurance company is simply embracing your own doctor's opinions.  Do not let this happen.

At Frankel & Newfield, P.C., a partner will collaborate with the Attending Physician to ensure that they understand your occupational requirements and how your disability has an impact on your day to day work, upon your restrictions and limitations and how this needs to be properly defined for purposes of the Long Term Disability claim.

Medical Evaluations that are Not Necessarily Required and Rarely Independent

We see this every single day.  A claimant is told to go for an IME (Independent Medical Examination) that is anything but independent.  IME doctors usually have long standing relationships with insurance companies.   Or, claimants are told to appear for a Functional Capacity Evaluation (FCE) at the request of the insurer.  The FCE request is not always required by your policy - but the insurance company insists it is - and some of the FCE's we have seen are actually dangerous to claimants.

These reports, prepared by doctors who are on the insurance company's payroll, (paid by the insurer or their agent), indicate no limitations on returning to work. The insurer utilizes this report to deny or terminate the claim.

At Frankel & Newfield, P.C., our clients appear at IME's and FCE's only after significant negotiations with the insurer regarding the examiner, the tests to be conducted and the scope of the examination. In addition, we often appear at these examinations with our clients to protect their rights.

Failing to Work with An Experienced Long Term Disability Insurance Lawyer

Insurers rely on the relative inexperience of claimants in order to manipulate and delay the claims process.  By bringing in an experienced and aggressive Long Term Disability Insurance lawyer at the outset of a claim, policy owners can prevent many delays in claims processing.

Many times, administrative appeals are available to claimants, which, if skillfully used, can lead to getting the claim approved. If the appeals process is not used properly, this can lead to an irreversible claims denial. Under no circumstances should a claimant ever pursue an appeal without legal counsel.  Although it should go without saying, a claimant's request for appeal without submitting documentation proving disability under the policy terms is worthless and can jeopardize any future claims.

A claimant's reliance on the insurer to "review" a denial by requesting an appeal without thoroughly and fully documenting the Long Term Disability claim is nothing less than an opportunity to rubber stamp the original denial and force litigation - where a claimant can be at a decided disadvantage.

At Frankel & Newfield, P.C., our experienced partners guide our clients throughout the Long Term Disability claims process and into litigation where appropriate. We have successfully appealed claim denials and obtained payments of arrears and ongoing benefits for many clients from many of the major insurers, including UNUMProvident, First Unum, Paul Revere, Provident, CIGNA, Hartford, Trustmark, Met Life, Prudential, The Equitable, Disability Management Services ("DMS"), Monarch, Guardian, Jefferson Pilot, Berkshire, Security Mutual, CNA, AIG, Fortis, Liberty Mutual, National Life of Vermont, Penn Mutual, Mass Mutual, Connecticut General Life Insurance Company, Reliastar, ING, Genworth Financial, Sun Life, Northwestern Mutual and many others.