Disability benefits appeal denied despite primary MD’s report

A couple of weeks ago we overheard someone at lunch talking about his disability claim. He was talking about a ski trip he’d taken a few years back that ended abruptly when he broke his left leg and right wrist in a nasty fall. He was laid up for weeks, and he had applied for long-term disability benefits through his job.

“Those jerks,” he said. “They denied me! I hated that company. They didn’t do a thing for their employees.” He added that he moved to Milwaukee shortly after that and has been happily employed since.

It is just rude to butt in to other people’s conversations, but oh is it tempting. We successfully stifled the urge to tell him that his old company actually did do something for its employees: It offered LTD insurance. We would have explained to him that his beef probably was with the insurance company, not with his employer.

Most companies purchase LTD coverage the same way they purchase health and dental policies for their workers. They look at costs and weigh the pros and cons of the plans, just as we would do for a car or home. All the employer does is buy the insurance. After that, the insurer takes over, especially when an employee has a claim. (We are speaking generally here; your employer may go through a different process.)

The insurer doesn’t care if the claimant is a good employee or a slacker; it doesn’t care if the employee has been there for 30 years or 30 days. The insurer looks at the evidence that supports the claim, paying close attention to the doctors’ reports.

A recent case shows how important the physician reports are. We’ll discuss the details of the claim, the denial and the appeal in our next post.

Source: Leagle.com, Carrow v. Standard Insurance Co., — F.3d —-, C.A.8 (Mo.)


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