LTD Insurance Basics

If you have been injured or become ill and can’t work, but your long-term disability (LTD) insurance company denied you benefits, you should hire an attorney. Unlike the Social Security Administration, LTD insurers are not impartial. They have an interest in the outcome of LTD claims because the more LTD claims they pay, the more it affects their bottom lines. The fewer LTD cases they approve for payment, the greater their profit margins.

Many commentators say LTD companies use unfair tactics to deny benefits. For example, LTD companies often conduct surveillance on benefit claimants. Company investigators secretly stalk them and take videos of their activities when they haul heavy trash, shop for groceries, even when they bend down to pick something up. Later, they may use this video evidence to justify denial of LTD claims or even to argue that LTD applicants misrepresent their conditions.

Such video footage of claimants is often unfair to them when it doesn’t show the whole picture. It can record an ill or injured worker taking a heavy load of trash to the curb or bending down to pick something up but probably won’t show the worker afterward resting and recuperating from the stressful physical activity. LTD companies are notorious for recording only the evidence that may damage a disability claim, not support it.

How Preexisting Conditions Affect Long-Term Disability Claims

Preexisting conditions, which are medical issues you had before your long-term disability (LTD) policy became active, can impact your claim for benefits. These conditions include both physical and mental health issues that were diagnosed or treated prior to your policy’s effective date.

Insurance companies scrutinize preexisting conditions closely when evaluating LTD claims, as they have a financial incentive to limit payouts. They may use these conditions to reduce their liability, avoid long-term benefit payments, or argue that your disability is not new or covered under the policy.

This scrutiny underscores the importance of being prepared and understanding your policy’s specific terms according to the law. The impact preexisting conditions may have on your LTD claim can vary based on several factors:

  • Differences in state laws, for example, between New Jersey and New York
  • Policy terms and conditions often vary by insurer
  • Your specific medical history and current condition may also play a role

These variations underscore the importance of having an experienced lawyer familiar with local laws and insurance practices. New York and New Jersey insurance policies often include specific time frames for defining preexisting conditions. For example:

  • Lookback periods range from six months to one year in both states
  • Conditions treated during the lookback period may be excluded from coverage

Even if your claim is initially denied due to a preexisting condition, it doesn’t mean you’re out of options. You can still challenge these denials and potentially secure your benefits. This process may involve carefully reviewing policy terms and definitions, gathering comprehensive medical evidence and considering the specific nature of your disability and its relation to any preexisting conditions.

When challenging a preexisting condition denial, it’s important to understand the distinction between your policy and the relevant state laws. For example, some policies may have exceptions for conditions that were successfully treated and didn’t recur for a certain period. Others might cover a disability if it’s significantly different from or unrelated to the preexisting condition.

Importance Of Representation

Because LTD companies sometimes do not handle claims fairly, legal representation for LTD claims is more important than for many other insurance claims. In fact, for several reasons, it makes sense for claimants to consult with experienced attorneys before filing for or being denied LTD benefits. At the outset of an LTD claim, the insurance company, ostensibly as a part of regular claim processing procedures, may ask for information that it intends to use against the claimant. The company also may try to have the claimant sign consent forms for release of information, credit information as an example, to facilitate its investigation. Most claimants for LTD benefits comply willingly with every such insurer request for information. Assisted and represented by an attorney from the outset, the claimant has the protection of expert advice about what to do and not to do for best results.

It’s particularly important to retain a disability lawyer before any decision is reached on whether the claim for benefits should be granted. Once the administrative appeal process is over, the record is closed, and no new evidence will likely be allowed in court. This makes it is critical that a lawyer be retained to handle the administrative appeal, to assure that the record is adequate. Waiting until after the administrative appeal is decided before hiring a lawyer may very well be too late.

LTD insurers count on claimant ignorance of their rules and procedures and consequently poor chances of fighting successfully for LTD benefits despite dutiful, timely payment of all premiums. To level the playing field with those who play unfairly, hire a knowledgeable New York/New Jersey disability lawyer experienced with LTD claims.

Contact Disability Lawyers That New York And New Jersey Residents Trust

LTD insurance is available in group plans through employers or through individual policies purchased directly through agents and brokers. Many policyholders prefer private plans because they typically offer better benefits than do employer-sponsored plans. LTD insurance replaces earnings if the policyholder becomes unable to work because of an LTD injury or illness, work-related or not; however, the sad fact is that some insurers deny too many initial claims, valid or not.

Even after claimants validate their disability claims and receive benefits, insurance companies look to reduce their obligations by buying out claims and negotiating settlements on terms favorable for them but not for claimants. Claimants need knowledgeable advocates to help them through the complexities of claim procedures and buyout details to make sure they get and keep their fair shares of benefits. Contact our New York / New Jersey disability lawyers, who also practice throughout New York, today at 201-342-7100 for a free case consultation