Long-term Disability Insurance Frequently Asked Questions

Long-term disability insurance questions that we have compiled over the years helping our clients better understand the landscape as we help them navigate through the best options to challenge a denied or delayed claim.

What is long-term disability insurance?

Long-term disability insurance policies are typically taken out by high-income professionals who have chosen to protect themselves and their families by purchasing a private disability policy. The policies are designed to cover lost wages in the event the insured is disabled by an accident or sickness. The private long-term disability insurance policy protects the insured if he or she is unable to work in their own-occupation for an extended period of time, or even perhaps forever.

Private long-term disability insurance policies are common in middle and upper-level management positions and owner-operated professions including doctors, surgeons, nurses, EMT workers, lawyers, dentists, dental hygienists, occupational therapists, and physical therapists.  Learn more about the types of professionals that seek out private long-term disability insurance coverage in our blog. Learn more about long-term disability insurance claims from our essential guide

How do I qualify for long-term disability insurance benefits? 

If you are disabled by an accident or injury AND if you are enrolled in an insurance coverage program through your work or you have purchased a private insurance policy, you should qualify for disability insurance.  Insurance companies such as UNUM, Cigna, Aetna, The Hartford and others, have specific and unique terms that will determine if you are eligible for benefits and for how long.  Generally, you should qualify for private disability insurance if you cannot work in your own occupation for an extended period of time due to an event where you are disabled by an accident or injury. 

Each insurance company writes its own policies, and the language they use may feel deliberately confusing. As a policyholder, we strongly recommend that you carefully review the full text of your policies, as there are likely to be many complex rules that define the precise nature of a disability and how you may or may not qualify to receive disability benefits. You need to understand the specific details of your policy before you submit a claim so that you do not accidentally give the insurance company a reason to deny your claim. We can help you understand and interpret your policy to determine what kind of coverage you might have.

Long-term disability insurance questions about filing claims:

When do I file a disability insurance claim?

You should file your disability insurance claim as soon as possible. Once you notice signs of injury or illness because of an accident, you should begin to detail your disability, talk to your doctors about your treatment options, and begin the insurance filing process.

Can I file a disability claim if I am still working? 

You must stop working or dramatically reduce your working hours to be considered for disability. You can continue working and still file a claim for benefits, although whether you are entitled to those benefits will depend on the specific terms of your policy. 

Depending on your disability, you may not be able to work at your original occupation, but you may be able to take on a new role to accommodate your disability and still qualify for benefits.

How do I make a disability insurance claim?

A long-term disability insurance claim can usually be filed online on the website of your disability insurance company. You may also call the insurance company, send them a fax, or submit your claim through the mail. You will need to submit claim forms along with medical records. Depending on the details of your policy and claim, you may also be required to provide financial documents. When you work with our disability insurance attorneys, we will be able to guide you through the filing process.

Long-term Disability Insurance Questions About Claim Denials.

Why was my disability insurance claim denied?

Your disability insurance claim may have been denied for several reasons. Many valid disability insurance claims are denied due to insurance companies acting in bad faith. Claims may be denied because insurance companies determine that there is not enough substantial medical evidence. 

What do I do when my disability insurance claim is denied?

Time is of the essence when you’ve received a claim denial. You should not accept the denial of your rightful insurance claim. Your insurance provider is hoping you will give up and accept your denied claim. Instead, consider taking action and begin exploring your options for refuting your claim. We can help you to determine what actions to take and can guide you through the process of responding to your insurance claim denial in the most efficient manner.

Speak with one of our California private long-term disability insurance lawyers at Donahue & Horrow, LLP to understand your rights and possible avenues for recourse. Insurance denial cases are unique from other types of legal cases and we have the kind of special experience necessary to get our clients the results they deserve. The sooner you contact us, the faster we can get to work on your behalf. Our initial consultation is FREE.  Additionally, you do not pay us any fees unless we win your case.

How long can I wait before I file a disability insurance lawsuit?

The sooner you file the better. Do not wait. There may be strict time deadlines that must be followed or you will lose your right to file a claim.

How can a long-term disability insurance lawyer at Donahue & Horrow help me?

We can help if your long-term disability insurance claim has been denied, delayed, or underpaid. We know that you are dealing with an injury or illness and the last thing you need is the headache of fighting for your insurance proceeds. We will do that for you so that you can focus on adjusting to your new normal. 

Our experienced California disability insurance attorneys will listen to your story – from when you purchased your disability insurance policy to when you became disabled – and create a plan of action tailored to your case and your circumstances. We will fight the disability insurance carriers to get the result you need. Meet with one of our experienced disability insurance attorneys to understand your rights and the path to recovering your funds. 

What is the difference between private long-term disability insurance and disability insurance provided by my employer?

Private long-term disability insurance is purchased directly from an insurance company, or through an agent or broker and you are responsible for paying insurance companies their premiums. If you have this type of coverage, you can sue the insurance company for breach of contract, breach of the implied covenant of good faith and fair dealing (commonly known as bad faith), and punitive damages. If you prevail at trial, the insurance company will most likely be required to pay you the back benefits you are owed, in addition to bad faith damages, emotional distress damages, and attorneys’ fees.

If your disability insurance coverage is provided as a benefit of employment, unless you work for a government agency or a church, your claim will be governed by the Employee Retirement Security Act of 1974, also known as ERISA. Under ERISA, if you prevail at trial, your recovery will be limited to your past-due benefits and possibly attorneys’ fees.

What is insurance bad faith?

Unfortunately, securing a long-term disability policy and paying regular premiums does not guarantee peace of mind. Even after regularly paying costly premiums for years, your insurance company may still deny your claim. You invested in private long-term disability insurance to plan for the unlikely occurrence that you get injured, to ensure a vital source of income for you and your family, in the event of a long term illness or serious injury. Yet, with increasing frequency, insurance companies are denying claims. From a bottom-line perspective, it is not in the insurance company’s best interest to pay claims in full, and many have devised numerous ways to either reduce or deny valid claims. When insurance companies wrongfully deny or delay the claims of unsuspecting policyholders, they are acting in violation of the implied covenant of good faith and fair dealing or in “bad faith.” 

When determining whether the insurance company acted in bad faith, courts apply a “reasonableness” standard. If you can prove that the insurer’s actions were unreasonable or without proper cause, then the insurance company will be found to have acted in bad faith. This will potentially entitle you to contract damages as well as emotional distress damages, financial damages, and attorneys’ fees.

What tools will the insurance company use to deny my disability insurance claim?

Insurance companies make money by collecting premiums, not by paying claims. Once you file a claim, you represent a potential loss to the insurance company. Thus, insurance companies try a variety of things to try to prevent having to pay your claim. Such tactics include, but are not limited to:

  • Falsely claiming that there is not enough medical evidence to support your claim
  • Refusing to believe that your subjective complaints — such as pain and fatigue — are real
  • Relying on the opinions of in-house doctors, whose opinions overwhelming tend to support their employer, the insurance company
  • Hiring so-called “independent” outside physicians to review your medical records, with the expectation that those doctors will also produce reports that will support a denial
  • Failing to talk to your doctors, or even worse, calling your doctors without an appointment so they are unprepared and attempt to trick them into saying that you are not disabled
  • Conducting surveillance of your daily activities in an attempt to “catch you” acting in a manner inconsistent with your claimed restrictions and limitations
  • Reviewing your social media posts and using what they find against you
  • Misrepresenting your actual job duties
  • Not fully advising you of your rights and obligations under the policy
  • Stalling by asking for more and more records to support your claim, even if you already provided them with access to all of your medical records
  • Attempting to rescind your policy because the insurance agent did not include information that you told him or her but they failed to include that information on your application
  • Failing to be specific in the information that you can provide to support your claim

Your long-term disability claim may have been denied for several reasons, but you should never accept a denied claim. You should always fight for your claim and challenge your denied claim. We are relentless and will help to provide you with the resources that you may need to challenge and fight for a reversal of your denied claim.

Did I wait too long to challenge the insurance company’s decision to deny my disability insurance claim?

All insurance policies have deadlines by which certain actions must be taken. On top of that, there are particular State and Federal guidelines that may apply to your claim. If your claim is denied, your best option is to act as quickly as possible. Mark any deadlines on your calendar because missing a deadline is the quickest way to lose the opportunity to otherwise make a valid claim.

Why should I hire D&H to help me fight for my disability benefits?

Our team at Donahue & Horrow, LLP has extensive experience in getting our clients the insurance disability benefits that they deserve. We have worked relentlessly to recover over $190 million for our clients. With over 80 years of experience, we combine a detailed understanding of the medical and insurance industries with a dedication to producing results for our clients. We fight for our clients and develop a relationship of success with them. 

Will the insurance company review my social media posts?

Social media is no longer only for connecting with your friends and family. Insurance companies have learned how to use your social media posts and take them out of context to serve their needs. 

Your insurance company will review any source of information about you in order to find a reason to deny your claim. Most people try to put their “best foot forward” on social media, and certainly do not typically promote their own disability and related symptoms, restrictions, and limitations. However, insurance companies will take your posts — perhaps showing you at the beach or at a party — to argue that you have not been honest about your disability. If you are considering filing an insurance claim, you should update your privacy settings so only your closest friends and family can see your posts, or better yet, stop posting altogether.

What law governs my claim?

If you purchased your insurance policy directly from the insurance company, through an agent, or through a broker, your claim is governed by the laws of the state in which you live while filing your claim. However, if your disability insurance coverage was provided as a benefit of employment, your claim, and any subsequent lawsuit will likely be governed by the Employee Retirement Security Act of 1974, more commonly known as ERISA.

Each state regulates insurance claims differently. The California Department of Insurance manages insurance claims and sets forth rules and regulations that the insurance companies are supposed to follow. Our team of attorneys is experienced in understanding the insurance regulations in California and ERISA so that we can advise our clients on each insurance claim.