Adverse benefit determinations are critical aspects of ERISA long-term disability claims. They refer to a decision made by an insurance company or plan administrator that denies or limits a claimant’s benefits. Understanding adverse benefit determinations is essential for claimants navigating the complex world of long-term disability claims. Understanding Adverse Benefit Determinations Adverse benefit determinations can …
Long-Term Disability Denials and Appeals
How to Get Your Claim File and Policy After a Long-Term Disability Denial
Navigating the complexities of a long-term disability denial can be overwhelming. After facing a denial, understanding how to request your claim file and policy is crucial. Reviewing your claim file is essential to gain insight into the reasons behind the denial and to explore potential avenues for appeal. This guide will walk you through the …
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Peer Review Reports in Long-Term Disability Appeals and Why You Should Respond
It is not uncommon for a disability insurance company to order a peer review during the long-term disability appeal process. If your insurer has requested a peer review, you may have received a letter that states something like: We are writing to update you of the status of your appeal request for the above referenced …
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Three Steps To Take If Your Long-Term Disability Claim Is Terminated
Today, we will discuss the steps you should take if you’ve received long-term disability benefits and the insurance company has terminated your claim. Here are the three steps to take following the termination of your long-term disability claim. Step 1: Request Your Claim File The first thing you need to do is request your claim …
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The Standard of Review in ERISA Long Term Disability Lawsuits
How will a federal judge make a decision about an ERISA lawsuit? There are two standards of review in ERISA cases: (1) the de novo review standard and (2) the arbitrary and capricious standard (also called the “abuse of discretion” standard). The judge will determine which standard applies to your disability based on the language …
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What To Do After the Final Long-Term Disability Denial
Today, I want to talk to you about what to do after you receive your final long-term disability denial letter from the insurance company. When I say final, what that means is when you file for long-term disability benefits, if you’re denied, you usually have a right to at least one, if not two, appeals. …
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Did Your Insurance Company Use the Wrong Policy Language in Your Long-Term Disability Denial?
Insurance companies often use “boilerplate” language when denying a long-term disability claim. Boilerplate language refers to a long-term disability denial letter that uses standard, pre-written language or a generic explanation rather than a detailed explanation specific to the individual’s claim. Boilerplate denials are often generic and do not provide specific information to explain why the …
Long-Term Disability Denials: 12 Reasons Your Claim Could Be Denied
When applying for long-term disability (LTD) insurance benefits, you must know that disability insurance companies deny many claims. Even if your disability insurance claim is initially approved, you need to know that your insurance company can terminate or cut off your benefits. If the insurance company decides you are no longer disabled, they can terminate …
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How to Appeal a Long-Term Disability Denial: Your LTD Appeal Guide
My name is Nick Ortiz, and I am a national long-term disability attorney who has been appealing long-term disability claim denials since 2005. I wrote this LTD appeal guide to help non-attorneys successfully appeal a wrongful denial or termination of benefits. My mission is to provide you with the same forms and tactics I use …
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Why Are Long-Term Disability Denials After Two Years So Common?
Many people on long-term disability worry about whether they will continue to receive benefits beyond the two-year mark, and for a good reason: Long-term disability denials after two years are common because most disability insurance policies change the definition of disability or will no longer pay benefits for certain conditions after benefits have been payable …
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