In neighborhoods like North Broad and Allegheny, disability is more common than many people realize. Nearly half of adults here live with a disability. That is much higher than both the city and national average.
For many, long term disability insurance is supposed to be a safety net when illness or injury makes working impossible. You pay your premiums for years. You trust the system. But then the denial letter arrives. Sadly, a real disability is not always enough for an insurance company to approve your claim.
Many People Do Not Even Know They Have LTD Coverage
This surprises many people. Someone calls our office about Social Security Disability. They are unable to work and desperate for help. During our conversation, we discover they actually have long term disability insurance through their job. They had no idea.
This happens often with doctors and nurses at hospitals like Temple. You may have signed up for benefits during orientation years ago. Or your employer may have enrolled you automatically. Life got busy and you forgot. That policy could now pay you thousands of dollars each month, often more than Social Security.
We have helped physicians, nurses, executives, and other hospital staff in North Philadelphia get the benefits they were promised. Many first came to us asking only about Social Security. If you cannot work, check your benefits paperwork. You may already have coverage waiting for you.
Why Insurance Companies Deny Disability Claims
Insurance companies do not always play fair. They are in business to make money. Every denied claim saves them money. They know that many people, already worn down by illness and bills, will give up. That is exactly what they want.
Denials often come down to technicalities:
- Policy definitions of disability. Some policies say you must be unable to do your own job. Others say you must be unable to do any job. For a surgeon with hand tremors or a nurse with a serious back injury, that difference matters.
- “Insufficient” medical evidence. Insurers often claim you did not provide enough proof, even when your doctors know you cannot work. In North Philadelphia, where getting specialized care can be a challenge, this feels especially unfair. Conditions like chronic pain, fibromyalgia, mental health disorders, or long COVID are harder to show on paper. That gives insurers an excuse to deny more claims.
Healthcare Workers Get Denied Too
Many of our clients work in healthcare themselves. Doctors, nurses, and hospital executives at Temple University Hospital often carry strong policies through their employers. These policies can pay 60% or more of a high salary for years, sometimes until retirement.
But when illness, injury, or mental health challenges force them to step away, they face the same denials as everyone else. In fact, insurance companies often target higher earners because the benefits are larger. Every month they do not pay you is money they keep.
We have won cases for Temple cardiologists, emergency room nurses, and hospital administrators who were told their conditions were not severe enough. We have represented many healthcare workers in North Philadelphia who were wrongly denied despite years of payments and clear medical evidence. If you work in healthcare and your claim has been denied, you know your condition is real. We make the insurance company see it too.
The 180 Day Window: Do Not Miss It
If your claim is denied, you have the right to appeal. But time is short. Federal law gives you 180 days from the date on your denial letter to act. Miss that deadline and you may lose your right to fight back.
This appeal is critical. It is your chance to submit medical records, statements from your doctors, and arguments that directly address the insurance company’s reasons for denial. If your case later goes to court, the judge will only look at this appeal file. That is why it must be done right the first time.
Your Rights Under ERISA
Most employer sponsored disability plans fall under a federal law called ERISA. This law gives you the right to appeal but the rules are strict and complicated. One mistake could cost you your benefits. Having a lawyer who understands ERISA can make all the difference.
Frequently Asked Questions
What is the difference between short term and long term disability insurance? Short term disability pays for a few months after an illness or injury. Long term disability begins after short term ends. It can last for years, sometimes until retirement.
How is long term disability different from Social Security Disability? Long term disability is private insurance, usually through your job. Social Security is a government program. LTD usually pays more and is often easier to qualify for if you cannot do your specific job. Some people can get both, but you should always check your LTD coverage first.
Do hospital employees have better coverage? Often yes, especially physicians and executives. But better coverage does not mean automatic approval. We have seen many denials for doctors and nurses in North Philadelphia who had excellent policies.
Can benefits stop after being approved? Yes. Many policies change after 24 months. They switch from “own occupation” to “any occupation.” That allows insurers to argue you can do another job, even one that pays much less. If this happens, you can still appeal.
What should I do if I get a denial letter? Read it carefully. Write down the appeal deadline. Collect your medical records and your policy. Then call a disability attorney right away.
What if I am not sure I even have coverage? Check with your HR department or look through your benefits paperwork. If you work at a hospital or a large employer, there is a good chance you do. Even if you signed up years ago and forgot, the coverage may still be active. Call us and we can help you find out.
You Do Not Have to Fight Alone
Living with a disability is hard enough. You should not also have to fight an insurance company for the benefits you earned.
If your long term disability claim has been denied in North Broad, Allegheny, or anywhere in North Philadelphia, we can help. We have stood with hospital executives at Temple, warehouse workers on Allegheny Avenue, nurses, and tradespeople across the city. We have guided people through appeals and fought to restore their benefits.
I know this community. For years I traveled through North Philadelphia almost every day. Some of my own doctors are at Temple. This is not just a place on a map to me. It is personal. That is why helping people here fight unfair denials matters so much.
But time is running. You only have 180 days to appeal. Call us today at 1-800-CANT-WORK or visit 1800CantWork.com. Your disability is real. So are your rights.
