What it Means to File a Lawsuit Against Your Insurance Company for LTD Denials

Filing a long-term disability (LTD) claim is often a critical step for individuals unable to work due to severe health conditions. However, when your insurance company denies your claim, the path to securing the benefits you deserve may lead to litigation.

Here, our nationwide claims attorneys at Disability Insurance Law Group explain why filing a lawsuit against your insurance company for an LTD denial is a significant decision. Understanding the process is essential to navigating it successfully.

Why Insurance Companies Deny LTD Claims

Insurance companies are for-profit entities, and paying out disability benefits directly impacts their bottom line.

Denials often stem from reasons such as:

• Insufficient Medical Evidence: The insurer may argue that your medical records do not sufficiently prove your disability.
• Pre-Existing Condition Exclusions: Claims may be denied based on pre-existing condition clauses in your policy.
• Policy Interpretation: Insurers might interpret the language of your LTD policy in their favor to justify a denial.
• Claimant Surveillance: Insurers may conduct surveillance and claim your activities are inconsistent with your reported limitations.

What Filing a Lawsuit Entails

If your LTD claim is denied, you can file an appeal through the administrative process outlined in your policy. However, if your appeal is also denied, you may need to file a lawsuit to pursue the benefits you are entitled to.

Here is what that process involves:

• Administrative Record Review: LTD lawsuits are often decided based on the administrative record compiled during your initial claim and appeal. This record includes medical evidence, policy documents, and correspondence with the insurance company. Ensuring your record is thorough and accurate during the appeal process is crucial.
• Legal Standard of Review:The court’s review of your case depends on the legal standard applied:
  • De Novo Review: The court examines the case without deference to the insurer’s decision.
  • Abuse of Discretion: The court defends the insurer’s decision, overturning it only if deemed unreasonable or arbitrary.
• ERISA vs. Individual Policies: Most LTD claims are governed by the Employee Retirement Income Security Act (ERISA), which imposes specific procedural rules and limits damages. However, if your policy is an individual plan, your lawsuit may not be subject to ERISA, allowing for broader remedies such as emotional distress or punitive damages.
• Timeframe and Patience: Litigation can take time. While waiting for a resolution, it is essential to continue managing your condition and maintaining updated medical records.

Why You Need Legal Representation

Filing a lawsuit against your insurance company is a complex process that requires a deep understanding of disability law, insurance policies, and court procedures.

Our experienced disability insurance attorneys can:

• Analyze your policy and claim denial.
• Build a compelling case by gathering additional evidence or expert opinions.
• Advocate for you in court, ensuring your rights are protected.

If your LTD claim has been denied and you’re considering legal action, don’t face this challenge alone. Our experienced nationwide LTD insurance claims attorneys are dedicated to fighting for your benefits and holding insurance companies accountable. We’ll guide you through the litigation process and work tirelessly to secure the benefits you deserve.

Contact Disability Insurance Law Group today at 954-989-9000 or online for a free consultation. Let us help you take the next steps toward obtaining the benefits you need to move forward with your life.