Precautions To Take To Avoid Long Term Disability Fraud

There are several ways you can avoid long term disability claim fraud.  Before filing an LTD claim, ensure you fully understand your policy.  Be attentive to deadlines, definitions, premiums, and waiting periods.  Typically the policy will impose a deadline within which to file your claim.  If you miss that deadline, the insurer/employer who provides your policy will likely deny the claim.  Read more below.

Understand Your Policy

You must meet your policy’s definition of “disabled”; not all disabilities are covered, such as substance abuse.  Also, unique rules apply to disabilities related to mental conditions.

Your policy provider may require you to file for Social Security Disability benefits in addition to LTD. The insurer will offset Social Security Disability Insurance (SSDI) payments, i.e. reduce the amount of your benefits by the amount SSDI pays.

Whether your claim is granted will largely depend on presenting the proper evidence, specifically your medical records.  You should attend all doctor’s and/or physical therapy appointments and follow your doctor’s instructions.  The insurer may place you under surveillance to observe your activities.  If any activity is inconsistent with your disability claim, it may be denied.  For example, your job duties require lifting boxes and you claim disability due to a bad back.  If surveillance shows you at the gym lifting weights or at the park picking up your children, that may provide a basis for denial.

The insurer is not concerned with your best interests; its objective is saving money and will deny benefits when it has a basis for doing so.  However, our New York long term disability lawyers have a duty to protect and zealously represent your interests.

What is Long Term Disability Fraud?

Long-term disability fraud is actually bad faith insurance, meaning an insurer has wrongfully denied, wholly or partially, a valid claim.  Such fraud arises where the insurer fails to investigate a claim, underpays benefits, or delays benefits without proper cause.  You should consult our New York long term disability attorneys if you suspect fraud.

How To Avoid Long Term Disability Fraud

While you cannot predict how your policy provider will handle your claim, you can be proactive in avoiding fraud.  Before purchasing a policy, research the insurance company.  If the benefits are provided through your employer, thoroughly read all documents governing the benefits.  Ask questions before you sign any documents, and seek independent legal counsel to fully inform you before entering into any policy. These documents are written by lawyers; you should have your own New York long term disability lawyer to interpret the legalese for you.

What If Your Claim Gets Denied?

If your claim is denied, you have the right to appeal that decision.  If your appeal is unsuccessful, you may bring a lawsuit against your insurer.  You must exhaust the appeals process at the administrative level before bringing a lawsuit.

Our New York long term disability attorneys will consult you on the appropriate claims or causes of action for your case.  Your case may include federal and state causes of action, including bad faith, breach of contract, and Employee Retirement Income Security Act violation(s).

You should continue paying any premiums while an appeal or lawsuit is pending to avoid giving the insurer any basis to continue denying or terminating your LTD claim.  Our New York long term disability lawyers can answer any questions you may have.