Each year, I review my calls and emails from prospective LTD clients, claims against LTD insurers and bases for denial. This past year, I have noticed less uber-aggressive tactics from the largest LTD insurer, Unum. Also, Portland LTD insurer Standard has shown willingness to be reasonable.
On the other hand, this past year I have fielded many calls from prospective clients upset with practices of Lincoln, Hartford and Met Life. The primary issue raised by callers involved LTD benefit recipient’s whose benefits were cut off long term disability benefits at the end of two year “Own Occupation” period. Usually, that is when a new “Any Occupation” period sets in. Some clients in this category do eventually qualify for “any occupation” benefits, but insurers, realizing the higher hurdle deny knowing that most will not appeal.
A second common denial scenario involves denied benefits for conditions with no clear diagnosis. This is can be an invalid basis for disclaimer. A clear diagnosis is rarely, if ever, required by long term disability policies. It’s just that insurers realize the difficulty of proving disability without a clear diagnosis.
The third most common basis for denial conditions involves conditions, such as fibromyalgia, which cannot yet be objectively verified by testing. Lack of “objective finding” is only a valid basis for denial when:
- The policy requires “objective findings; and
- When the condition is capable for objective verification.
