What to Do If a Doctor Denies Your Disability Claim You Never Saw

Have you ever had your long-term disability (LTD) claim rejected by your insurance despite never seeing the doctor who made the decision? Insurance companies often use these “third-party medical reviews” or “peer reviews” to reject LTD claims. If your claim was rejected even after a medical examination, you must check for the conditions that qualify for LTD and hire a medical disability lawyer.

An unknown doctor denied your disability claim. What’s next?

After an LTD denial, the first step is to carefully read the denial letter to determine the primary grounds for denying your claim.  

  1. Was it a result of insufficient medical evidence?
  2. Did the insurance provider believe you failed to meet the requirements for a disability?
  3. Did your medical history include any indications that led to the denial?

When you apply for LTD benefits, the insurance company may use your medical history and the evaluations of any qualified medical professionals you have contact with to determine your eligibility. It may contain data from your physician and observations from other attending medical professionals, such as treating medical specialists.

  • Requesting and reviewing your LTD policy and claim file

You must request the complete LTD claim file if your claim is rejected. The LTD insurance and plan documents should be provided in this as well. You have to carefully look through all those records with your attorney evaluating your file to identify any mistakes or inaccuracies made by the insurance provider. Understanding the policy’s coverages and exclusions and the types of medical proof needed to support your appeal are all essential components. You will be guided through this procedure by your attorney.

  • Collect All the Required Documents

Insufficient medical evidence is one of the most common reasons a medical reviewer rejects your claim. Your lawyer can help you collect the required documentation, get updated information from your providers, and ask them if they are going to support the disability claim in person. Be sure to collect any relevant proof, including exam and imaging findings, test results, and observations and notes from your doctor related to your disabilities.

  • Hire a qualified long-term disability lawyer.

Appeal procedures for long-term disability claims are complex and time-consuming. The ERISA federal legislation controls most employer-sponsored LTD plans, which provides insurance companies with certain advantages and makes it more challenging for claimants to win their cases.

A disability claim rejection under ERISA must frequently be overturned by showing that the insurance company’s judgment was “arbitrary and discriminatory.” The case is different from a normal contract violation.

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