Some long-term disability claims are lost because the person can still work. Many more are lost because of something the person did, or failed to do, along the way. A missed form. A doctor’s note that says “doing well.” A vacation photo. None of these mean you are not disabled, but each one gives the insurance company a reason to say no.
Here are ten mistakes to avoid, starting the day you stop working.
1. Filing without reading your policy
The policy defines “disabled,” sets your deadlines, and lists what is excluded and what is subtracted from your check. If you file without knowing whether your policy uses an own-occupation or any-occupation test, your forms and your doctor’s statements may answer the wrong question. Get the full policy first, not the benefits summary. More: Get your policy before you file.
2. Missing a deadline
LTD claims run on deadlines: notice of claim, proof of loss, responses to the insurer’s requests, the appeal (at least 180 days under ERISA), and the deadline to sue. A late claim can be denied before anyone reads your medical records. Write every deadline on a calendar the day you learn it, and send important documents in a way you can prove.
3. Letting your records show a diagnosis but not your limits
The insurance company rarely disputes that you are sick. It disputes whether your records show what you cannot do. Notes that say “stable” or “doing well,” list normal exam findings, or record symptoms without function will be read against you. Tell your doctor about your limits at every visit, in specifics, and ask for a functional statement with numbers. More: Why your doctor must describe limitations, not just diagnoses.
4. Gaps in treatment
Most policies require you to be under a doctor’s regular care. Months without a visit look like months without a problem, even if the real reason was cost, transportation, or a doctor who left the practice. Keep your appointments, follow your treatment plan, and if you must stop a treatment, make sure the reason is in your records.
5. Describing your limits differently in different places
You will describe your condition on claim forms, to your doctors, in phone interviews with the insurer, possibly at an independent medical exam, and in a Social Security application. The insurer compares them. If you tell one person you can sit for 20 minutes and another that you can sit for an hour, the insurer will question both. Before any form or interview, think about your typical day and your bad days, and describe them the same way every time.
6. Exaggerating, or downplaying
Both hurt. If you say you cannot drive at all and an investigator films you driving to the pharmacy, your credibility is gone. But if you say “I do the housework” without explaining that you vacuum one room, then lie down for an hour, you have understated your limits. The fix is the same for both: give the details. How long, how often, whether you need help or breaks, and what happens afterward.
Example: you report that you drive to the grocery store. The insurer reads that as proof you can sit for long periods. The full answer is that you drive 15 minutes twice a week, shop for about 20 minutes, and go home to lie down.
7. Forgetting that you may be watched
Insurers sometimes hire investigators to record what you do in public, and they may review public social media. A photograph captures a moment, not your whole day, and occasional activity is not the same as full-time work. But a gap between what you report and what someone sees can do serious damage.
- Assume anything you post publicly may be reviewed, including posts you think only friends can see.
- Think about how a post looks without context. A smiling vacation photo does not show the two days in bed afterward.
- Do not delete or alter posts to hide them once you have a claim. Destroying evidence creates a bigger problem than the post.
More: Can they cut me off because I drive, shop, or travel?
8. Ignoring the insurance company’s requests
Insurers ask for updated records, activity questionnaires, attending physician statements, phone interviews, and sometimes an independent medical exam. Failing to respond, or skipping an exam the policy requires, can be grounds for denial or termination on its own. Respond on time, keep copies of everything you send, and if a request seems unreasonable, talk to a lawyer before you refuse. More: What to expect at an independent medical exam.
9. Mishandling Social Security disability
Most group policies require you to apply for Social Security disability and reduce your LTD check by the amount Social Security pays. Two mistakes here: refusing or delaying the SSDI application when the policy requires it, and spending Social Security back pay before you know whether the LTD insurer is owed a reimbursement. When Social Security pays back benefits for months the LTD insurer already paid in full, the insurer will usually demand that “overpayment” back. More: My insurer wants more money than I received.
10. Treating the appeal as a letter of disagreement
If your claim is denied under an ERISA plan, the appeal may be your last chance to add evidence to your file. If you later sue, the court may look only at what the insurer had. A one-page letter saying “my doctor says I’m disabled” wastes that chance. A real appeal answers every reason in the denial letter with evidence. More: Should I appeal myself or hire a lawyer?
One more: going back to work without reading the policy
Trying to work again is a good thing, and some policies pay partial benefits while you do. But returning part time, starting a business, or doing occasional paid work can trigger a review or affect your benefits. Read your policy’s return-to-work and reporting provisions before you start, and report earnings exactly as the policy requires.
What all of these have in common
Every mistake on this list is easier to prevent than to fix. Most of them come down to three habits: know your policy, keep your treatment and your records consistent, and describe your limits accurately and in detail every time.
Starting a claim, or worried you have already made one of these mistakes? Call 770-351-0801 or request a free case evaluation. Many of them can still be addressed if you act before the insurer decides.
Related: Top 5 reasons LTD claims are denied · Own occupation vs. any occupation · Free LTD Survival Kit