Your Safety Net Just Said No. Now What?
When illness or injury keeps you from working, Long Term Disability insurance should step in. But here in Philadelphia, insurers often deny valid claims. That leaves families without income when they need it most. In fact, more than 30% of initial LTD claims nationwide are denied, according to the Council for Disability Awareness (2023). Knowing your rights and acting quickly is the first step to fighting back.
Why Do Insurers Deny Long-Term Disability Claims?
LTD benefits are supposed to replace part of your income if you can’t work. Unfortunately, insurance companies look for reasons to delay or deny payment. As a Philadelphia disability lawyer, I see common tactics like:
- Not enough medical proof. They argue your records don’t support your disability.
- Pre-existing conditions. They say your illness started before your policy took effect.
- Surveillance. Investigators might film you at Reading Terminal Market or even outside your home in Delaware County.
- Contradictory opinions. A doctor hired by the insurer disagrees with your treating physician at Jefferson Hospital.
Each tactic is designed to save the company money and not to protect your livelihood.
What Should You Do After a Denial?
Most LTD policies give you 180 days to appeal a denial. That’s not much time. Missing the deadline usually means losing your chance to ever challenge the decision in court. Here’s what matters most:
- Read the denial letter. It explains why your claim was denied and shapes your appeal.
- Gather more medical evidence. Ask your doctors at Penn Presbyterian or Temple University Hospital to address the insurer’s concerns directly.
- Consult a disability lawyer. An experienced Philadelphia attorney can manage the appeal and counter the insurer’s tactics.
- Keep records. Save every call, email, and letter. Even a short voicemail can become important later.
What Is ERISA and Why Does It Matter?
Most employer-sponsored LTD plans fall under a federal law called ERISA—the Employee Retirement Income Security Act. ERISA sets strict deadlines and rules for appeals. One mistake in the ERISA process could prevent your case from ever reaching federal court in Center City. That’s why having an attorney who is familiar with ERISA is so important.
At the heart of your case are your medical records. They need to show not just your diagnosis but your actual limitations. They must explain why those limitations prevent you from performing your job, whether it’s on Market Street in Philadelphia or across the bridge in Camden.
Frequently Asked Questions
How long do I have to appeal an LTD denial?
Most policies give you 180 days from the date of the denial letter. Miss that deadline, and you may lose your rights. Contact a lawyer immediately if the clock is ticking.
Can I work part-time while receiving LTD benefits?
Sometimes. Many policies allow “partial disability” benefits if you work fewer hours or earn less pay. Always check your policy and notify the insurer before returning to work.
What’s the difference between LTD and Social Security Disability (SSDI)?
SSDI is a federal program that requires you to be unable to perform any substantial work. LTD is private insurance and usually only requires that you cannot do your own job, at least for the first two years. You can often receive both, though SSDI may reduce your LTD payment.
Don’t Take on the Insurance Company Alone
Fighting an LTD denial while battling a serious health condition is overwhelming. Insurance companies have teams of lawyers protecting their profits. You deserve someone to protect you.
At The Law Offices of Eric A. Shore, we help people across Philadelphia, Delaware County, and South Jersey fight for the benefits they’ve earned. Call 1-800-CANT-WORK or visit 1800cantwork.com for a free consultation. There’s no fee unless we win your case.
