Common Mistakes People Make When Applying for Long-Term Disability Benefits

Applying for long-term disability benefits (LTD) can be a complex and frustrating process, especially if you’re dealing with a serious medical condition that prevents you from working. Many applicants make critical mistakes that result in unnecessary denials or delays in receiving benefits. 

If you’re applying for LTD benefits, understanding these common pitfalls can help improve your chances of success. Below, we discuss the most frequent mistakes people make and how to avoid them.

Failing to Review the Terms of the Disability Policy

One of the biggest mistakes applicants make is not fully understanding the terms of their long-term disability policy before applying. LTD insurance policies vary, and each has specific requirements regarding eligibility, coverage limits, waiting periods, and definitions of disability. 

Some policies cover only “own occupation” disabilities, meaning you qualify if you cannot perform your specific job, while others require you to be unable to work in any occupation to receive benefits.

Avoid This Mistake By:

• Carefully reviewing your policy’s definition of disability.
• Checking for exclusions or limitations that may affect your claim.
• Understanding the deadlines for filing and appealing a denial.

Not Providing Enough Medical Evidence

Insurance companies do not approve LTD benefits based solely on your word. Your application must include strong medical documentation that proves your condition prevents you from working. Many applicants submit incomplete or insufficient medical records, leading to a denial.

Avoid This Mistake By:

• Ensuring your doctor provides detailed notes about your diagnosis, symptoms, and treatment.
• Including test results, imaging scans, and lab reports that support your condition.
• Obtaining written statements from your physician explaining why you are unable to work.

Without clear and consistent medical evidence, the insurance company may claim that your condition is not severe enough to warrant benefits.

Continuing to Work Against Medical Advice

Some applicants attempt to keep working while waiting for their LTD benefits to be approved. However, if your doctor has advised you to stop working, continuing to do so can undermine your claim. Insurance companies may argue that if you can still work, you are not disabled.

Avoid This Mistake By:

• Following your doctor’s orders regarding work restrictions.
• Not engaging in any work, even part-time, if it contradicts your claim.
• Keeping records of any work-related difficulties you experience due to your condition.

Missing Deadlines or Filing an Incomplete Application

Insurance companies impose strict deadlines for applying for LTD benefits and appealing denied claims. Many applicants miss key deadlines or fail to provide all required forms and information, leading to automatic denials.

Avoid This Mistake By:

• Carefully reading your policy to understand all filing deadlines.
• Ensuring all forms are completed accurately and thoroughly.
• Keeping copies of everything you submit and tracking correspondence with the insurer.

Even a small administrative mistake can result in a rejection, so paying close attention to deadlines is crucial.

Ignoring Requests for Additional Information

After you submit your application, the insurance company may request additional documentation or ask you to attend an Independent Medical Examination. Ignoring these requests can lead to delays or denials. Some applicants assume that if they’ve already submitted their records, they don’t need to provide anything further. This is a big mistake.

Avoid This Mistake By:

• Promptly responding to all requests for additional records or statements.
• Attending all scheduled medical evaluations and cooperating with examiners.
• Keeping a log of all communications with the insurance company.

Failing to comply with the insurer’s requests can be used as grounds to deny or terminate your claim.

Overlooking the Impact of Surveillance and Social Media

Many applicants don’t realize that insurance companies conduct surveillance to find evidence that contradicts their disability claim. Insurers may hire private investigators to film you doing activities that suggest you are not as disabled as you claim. Additionally, social media posts can be used against you.

Avoid This Mistake By:

• Being cautious about what you post on social media. Avoid sharing photos or updates that could be misinterpreted.
• Following medical restrictions in public and private settings.
• Being aware that even normal activities can be taken out of context by insurance investigators.

If an insurer finds any evidence that contradicts your claim, they may use it to deny or terminate your benefits.

Relying Too Much on Your Doctor Without Seeking Legal Help

While your doctor plays a key role in supporting your LTD claim, some applicants make the mistake of assuming that their physician’s diagnosis alone will guarantee approval. Insurance companies have their own medical professionals who may dispute your doctor’s opinion.

Avoid This Mistake By:

• Working with an experienced disability attorney who understands how to build a strong case.
• Gathering additional evidence, such as statements from vocational experts.
• Being prepared to challenge insurance company decisions if they attempt to minimize your disability.

Handling the Appeal Process Alone

If your claim is denied, you have the right to appeal the decision. However, many applicants try to handle the appeal themselves, which often results in further denials. The appeals process is complicated, and insurance companies look for any reason to uphold their original decision.

Avoid This Mistake By:

• Seeking legal representation as soon as your claim is denied.
• Gathering new medical evidence or expert testimony to strengthen your appeal.
• Meeting all appeal deadlines and submitting a comprehensive, well-documented appeal package.

An experienced Philadelphia disability lawyer can help you navigate the appeals process and improve your chances of overturning a denial.

Get the Legal Help You Need at Edelstein Martin & Nelson

Applying for long-term disability benefits can be overwhelming, especially when you’re already dealing with a serious medical condition. Avoiding these common mistakes can increase your chances of approval and prevent unnecessary delays. If you’ve already been denied benefits, don’t give up; many initial denials can be overturned with a strong appeal.

At Edelstein Martin & Nelson, our hard-working Philadelphia long-term disability lawyers understand the tactics insurance companies use to deny claims. We are dedicated to helping disabled workers in Philadelphia and throughout Pennsylvania secure the benefits they deserve.

If you need help applying for LTD benefits or appealing a denial, contact us today for a free consultation. We will review your case, explain your legal options, and fight to get you the financial support you need. Call us now at (215) 731-9900 or fill out our online contact form to schedule your free case review.