Navigating Long-Term Disability Denials for Credit Union Employees

Credit unions are financial institutions that offer many of the same services as banks, such as savings accounts, loans, and credit cards. Credit unions offer a wide range of jobs, each designed to meet different needs and responsibilities. Common credit union jobs include:

• Tellers
• Loan Officers
• Member Services Representatives
• Branch Managers
• IT Specialists
• Financial Advisors
• Compliance Officers
• Marketing Specialists
• Human Resources

Long-term disability (LTD) insurance is an important safety net for credit union employees, providing financial support if you’re unable to work due to a serious illness or injury. Many credit unions offer disability insurance as part of a group benefits plan for employees. The top 10 credit unions in the U.S. (most likely to offer disability insurance to employees) are:

• Navy Federal Credit Union
• State Employees’ Credit Union
• Pentagon Federal Credit Union
• Boeing Employees’ Credit Union
• SchoolsFirst Federal Credit Union
• Golden 1 Credit Union
• America First Credit Union
• Alliant Credit Union
• Mountain America Credit Union
• Randolph-Brooks Credit Union

However, facing a denial of these benefits can be frustrating and daunting. Understanding why denials occur and how to effectively appeal a denial is key to securing the benefits you deserve.

Understanding Long-Term Disability Denials

LTD denials can occur for a variety of reasons, some of which are more common in the credit union industry. Here’s a closer look at the most common causes:

1. Insufficient Medical Evidence: Insurers require comprehensive medical documentation to support your disability claim. If your medical records are incomplete or do not support your inability to work, your claim may be denied.
2. Pre-existing Conditions: Policies often exclude conditions that were diagnosed or treated before your coverage began. If your disability is related to a pre-existing condition, the insurer may deny your claim.
3. Policy Exclusions and Limitations: Each LTD policy has its own set of exclusions and limitations. Some conditions may not be covered, or benefits may only be provided for a limited time.
4. Non-compliance with Treatment: Failure to follow prescribed treatment may result in a claim being denied. Insurers expect you to follow medical advice to improve your condition.
5. Inconsistencies in Your Claim: Any discrepancies between your claim form, medical records, and other documentation can raise red flags. Consistency is critical to a successful claim.
6. Vocational Assessments: Insurers may conduct assessments to determine if you can perform any job, not just your specific role. If they believe you can work in any capacity, they may deny your claim.

Steps to Take After a Long-Term Disability Denial

Receiving a denial isn’t the end of the road. Here’s a step-by-step guide to appealing the decision:

1. Review the Denial Letter

The first step is to carefully review the denial letter. This document outlines the specific reasons for the denial and provides details about the appeals process. Understanding why your claim was denied is essential to a successful appeal.

2. Gather Additional Evidence

Based on the reasons for denial, gather any additional evidence that may strengthen your case. This may include:

• Detailed Medical Records: Make sure all of your medical records are comprehensive and up-to-date. Include detailed notes from your healthcare providers that clearly explain your condition and how it affects your ability to work.
• Statements from Healthcare Providers: Obtain written statements from your doctors that specifically support your disability claim. These statements should address the insurer’s concerns and provide a clear link between your medical condition and your inability to work.
• Vocational Expert Opinions: Consider obtaining an opinion from a vocational expert who can testify to your inability to perform any job given your skills and limitations.

3. Write a Strong Appeal Letter

Your appeal letter is your chance to directly address the insurer’s reasons for denial directly and provide additional evidence to support your case. Here’s how you should structure your letter:

• Introduction: Clearly state that you are appealing the denial of your long-term disability benefits and include your policy number and other identifying information.
• Address Each Reason for the Denial: Systematically address each reason given in the denial letter. Provide new evidence and explanations to refute each point.
• Include Supporting Documentation: Include any additional evidence, such as updated medical records, statements from health care providers, and vocational expert opinions.

4. Meet Deadlines

LTD policies have strict deadlines for filing appeals. Be sure to file your appeal within the required timeframe to avoid losing your right to appeal the denial.

Tips for Strengthening Your LTD Claim

Preventing a denial in the first place can save you time and stress. Here are some tips to help strengthen your initial claim:

• Keep Detailed Records: Keep thorough records of all your medical treatment, including dates, diagnoses, prescribed treatments, and follow-up care. This documentation will be crucial if you need to file an appeal.
• Communicate Clearly with Your Health Care Providers: Make sure your doctors understand the specific requirements of your LTD policy. Ask them to include detailed notes in your medical records that clearly describe your condition and how it limits your ability to work.
• Follow Prescribed Treatments: Follow all prescribed treatments and therapies. If you have concerns or side effects, discuss them with your healthcare provider rather than stopping treatment on your own.
• Be Honest and Consistent: Provide honest and consistent information throughout the claims process. Inconsistencies can undermine your credibility and lead to a denial.

How a Long-Term Disability Lawyer Can Help

Navigating the complexities of an LTD claim can be overwhelming. Consulting with a legal professional who specializes in disability claims can provide valuable assistance. Here’s how an attorney can help:

• Expert Guidance: An attorney can help you understand your policy, identify the strengths and weaknesses of your claim, and develop an appeal strategy.
• Gathering Evidence: Legal professionals can help by collecting and organizing the evidence needed to support your claim.
• Communication with Insurers: Attorneys can handle all communications with the insurance company and present your case effectively and professionally.
• Representation in Court: If your appeal is unsuccessful, an attorney can represent you in court to fight for your benefits.

The Ortiz Law Firm Can Help You Appeal a Long-Term Disability Denial

Facing a long-term disability denial can be challenging, but understanding the reasons behind the denial and knowing how to appeal can make a significant difference. By being proactive, keeping detailed records, and seeking professional help when needed, you can navigate the appeals process and work toward a favorable outcome.

Our Case Results: Benefits Restored for Navy Federal Credit Union Employee with Bipolar Disorder

At the Ortiz Law Firm, we know a thing or two about helping credit union employees get the benefits they deserve. In one of our recent cases, the claimant was a Senior Internal Mail Specialist at Navy Federal Credit Union. She received her short-term disability benefits, but New York Life Group Benefit Solutions (NYL GBS) denied her long-term disability claim.

Recognizing the unfairness of this denial, we gathered additional medical records, expert opinions, and detailed reports on the claimant’s condition. Our comprehensive appeal highlighted the inconsistencies and omissions in NYL GBS’s initial review and presented an irrefutable case for the reinstatement of her benefits.

After a thorough review of our appeal, NYL GBS acknowledged the oversight, reversed its prior decision, and reinstated the claimant’s long-term disability benefits.

Call Us for a Free Case Evaluation

Remember, persistence is key. Don’t give up after a denial—use the appeals process to present a stronger case and fight for the support you deserve. We are here to guide you through the appeal process and offer a free case evaluation to discuss the circumstances behind your claim denial and how we can help you recover your benefits. Contact us online or call (888) 321-8131 to get started.