New Jersey Long-Term Disability Attorneys 

Types of Long-Term Disability Policies 

There are two primary types of long-term disability insurance policies available to workers: individual policies and group policies. Each type has distinct features that may influence the claims process, the benefits you’re entitled to, and the level of complexities involved in securing those benefits. 

Individual Long-Term Disability 

An individual long-term disability policy is purchased directly by the policyholder from an insurer. Many professionals, such as self-employed workers or those with highly specialized skills, choose individual policies to ensure comprehensive coverage tailored to their specific needs. 

Group Long-Term Disability 

Group policies are typically provided as part of an employee benefits package and cover all eligible employees under one plan. While these policies tend to be more affordable given their group pricing structure, the benefits offered are often less robust than those of individual plans. 

Group LTD policies are usually governed by the Employee Retirement Income Security Act (ERISA), which offers specific protections for employees while also presenting legal complexities in the event of a denial. Unfortunately, employer-sponsored group policies are often riddled with small print that can lead to disputes over coverage, pre-existing conditions, or the definition of “disability.” 

We have experience navigating both individual and group LTD policies, helping policyholders across different circumstances secure the benefits they deserve no matter what challenges they face. 

Call (973) 965-8571 or send us a message online – we’re here to help you with your long-term disability claim.

What Is ERISA and How Does It Impact Long-Term Disability Claims? 

ERISA is a federal law that governs most employer-provided long-term disability plans. ERISA sets specific requirements on how insurance companies and employers must manage disability benefits plans, providing some safeguards for employees. 

However, while ERISA offers vital protections, it also imposes technical hurdles for claimants. Strict deadlines, limited discovery rights, and deferential legal standards often favor the insurer. This makes proper legal representation critical if you’re navigating an ERISA-governed LTD dispute.

Am I Eligible for Long-Term Disability Claims? 

Eligibility for long-term disability claims hinges on the terms outlined in your specific policy. However, most LTD policies have general requirements, such as: 

• Coverage at the time of disability. You must have already been enrolled in long-term disability insurance when your disabling condition occurred. 
• Definition of disability. Policies often require you to prove that your condition prevents you from performing the essential duties of your current occupation (also known as “own occupation” coverage) or any occupation, depending on the policy. 
• Waiting periods. Many policies include an elimination period, often lasting 90 to 180 days, during which you must be continuously disabled before benefits become payable. 
• Ongoing medical documentation. You will typically need extensive medical records and certifications from your healthcare providers to demonstrate the severity of your condition and your inability to work.

Common Reasons Insurance Companies Deny Long-Term Disability Claims 

Insurance companies are notorious for issuing denials, often relying on technicalities or incomplete claims to avoid payout. Some of the most common reasons for LTD claim denials include: 

1. Insufficient medical evidence. Claims often fail due to incomplete or weak documentation of the disability. One in five employees do not realize the importance of detailed medical documentation in insurance claims, which can lead to lapses in gathering critical information from their healthcare providers.
2. Pre-existing conditions. Many insurance policies include specific exclusions for pre-existing medical conditions, often leading to invalidated claims. 
3. Failure to meet the policy’s definition of disability. Disputes often arise over how “disability” is defined within a policy, with insurers rejecting claims that don’t align with their strict interpretations. 
4. Missed deadlines or procedural errors. Insurance companies may deny claims outright if paperwork is late or incorrectly completed, even if all other criteria are met.

Our team methodically uncovers the root causes behind claim denials and creates a strategy to address these hurdles, allowing clients a chance to correct issues and move forward with their claims. 

Appealing a Long-Term Disability (LTD) Denial

Receiving a denial for your LTD  claim can be overwhelming, but it’s not the end of the road. You have the right to appeal, and with the proper steps and support, you can fight for the benefits you deserve. Here's what the appeals process involves and how we can help:

1. Understand the Reasons for Denial
   The first step is to carefully review the denial letter from your insurer. It should outline why your claim was denied, whether due to insufficient medical evidence, missed deadlines, or policy exclusions. Understanding these reasons is critical to building a strong appeal.
2. Gather Comprehensive Evidence
   Your appeal depends on presenting new, compelling evidence to support your claim. This may include updated medical records, expert opinions, treatment plans, or vocational reports that demonstrate your inability to work.
3. Adhere to Strict Deadlines
   ERISA regulations impose tight deadlines for filing appeals — often as short as 180 days. Missing these deadlines could forfeit your right to pursue your benefits, making it essential to act quickly.
4. File a Persuasive Appeal
   Your appeal isn’t just a chance to resubmit your claim; it’s an opportunity to create a complete and persuasive case for why the insurer’s denial was incorrect. This step requires meticulous preparation and legal knowledge.
5. Seek Expert Representation
   The appeals process can be highly technical, with insurers often relying on complex policy language and favorable legal standards to uphold their decision. Having experienced legal representation can level the playing field. Our team knows how to challenge the insurer's reasoning, present solid evidence, and protect your rights.