Navigating Long-Term Disability Denials For Credit Union Employees

Credit unions are financial institutions that provide many of the same services as banks, like savings accounts, loans, and credit cards. Credit unions offer a wide range of jobs, each catering to different needs and tasks. 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 a crucial safety net for credit union employees, providing financial support when they can’t work because of a serious illness or injury. Many credit unions provide disability insurance coverage as part of a group benefits plan for employees. The 10 largest credit unions in the U.S. (which are the most likely to provide employees with disability insurance) 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 happen and how to appeal a denial effectively is key to securing the benefits you deserve.

Understanding Long-Term Disability Denials

LTD denials can stem from various reasons, some of which are more common in the credit union sector. Here’s a closer look at the typical causes:

1. Insufficient Medical Evidence: Insurers require comprehensive medical documentation to substantiate your disability claim. If your medical records are incomplete or do not show 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 linked to a pre-existing condition, the insurer might deny your claim.
3. Policy Exclusions and Limitations: Each LTD policy comes with its own set of exclusions and limitations. Some conditions might not be covered, or benefits may only be provided for a limited time.
4. Non-compliance with Treatment: Failing to follow prescribed treatments can lead to a denial. Insurers expect you to comply with 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 crucial to a successful claim.
6. Vocational Assessments: Insurers might conduct assessments to determine if you can perform any job, not just your specific role. If they believe you can work in some 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 review the denial letter thoroughly. This document will outline the specific reasons for the denial and provide details on the appeals process. Understanding why your claim was denied is essential for a successful appeal.

2. Gather Additional Evidence

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

• Detailed Medical Records: Ensure that all your medical documentation is 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: Get written statements from your doctors that explicitly 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 seeking an opinion from a vocational expert who can testify to your inability to perform any job, considering your skills and limitations.

3. Write a Strong Appeal Letter

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

• Introduction: Clearly state that you are appealing the denial of your long-term disability benefits and provide your policy number and other identifying information.
• Address Each Reason for Denial: Systematically address each reason cited in the denial letter. Provide fresh evidence and explanations to counter each point.
• Include Supporting Documents: Attach all additional evidence, such as updated medical records, statements from healthcare providers, and vocational expert opinions.

4. Meet Deadlines

LTD policies have strict deadlines for filing appeals. Ensure you submit your appeal within the required timeframe to avoid forfeiting your right to challenge 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: Maintain thorough records of all your medical treatments, including dates, diagnoses, prescribed treatments, and follow-up care. This documentation will be crucial if you need to appeal.
• Communicate Clearly with Your Healthcare Providers: Ensure 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: Adhere to all prescribed treatments and therapies. If you have concerns or side effects, discuss them with your healthcare provider rather than discontinuing treatment on your own.
• Be Honest and Consistent: Provide honest and consistent information throughout your claim process. Inconsistencies can undermine your credibility and lead to a denial.

How a Long-Term Disability Attorney Can Help

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

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

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 denials and knowing how to appeal can make a significant difference. By being proactive, maintaining detailed records, and seeking professional help when needed, you can navigate the appeals process and work towards a favorable outcome.

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

At Ortiz Law Firm, we know a thing or two about helping credit union employees recover the benefits they deserve. In one of our past 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 documentation, expert opinions, and detailed reports on the claimant’s condition. Our comprehensive appeal highlighted the inconsistencies and omissions in the initial review by NYL GBS, presenting an irrefutable case for the reinstatement of her benefits.

After a thorough review of our appeal, NYL GBS acknowledged the oversight, overturned 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 appeal 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 the denial of your claim and how we can help you recover your benefits. Contact us online or call (888) 321-8131 to get started.