Long Term Disability Denials Based on Your Failure to Show Medical Improvement

Many Long Term Disability policies, such as Reliance Standard, require a showing of continued eligibility and they can ask for periodic updates to make sure that you continue to be eligible for Long Term Disability benefits.

The three common reasons that Long Term Disability claims are denied or suspended is that the Long Term Disability applicant can’t:

1. Show objective evidence of diagnosis
2. Show objective evidence of disability
3. Show objective evidence of the disability impact in your ability to do the material duties of your occupation

Long Term Disability carriers will suspend the payment of disability benefits in part, based on what you put on your disability questionnaire.

In Daugherty-Rosenbaum v. Life Insurance Company of North America (LINA), 2007 US District Lexis 5653 (d. or. January 24, 2000), benefits were denied on the basis that there was “no improvement in the plaintiff’s condition.”

LINA denied benefits based on a paper review arguing that there was no objective evidence of the claimant’s limitations to prevent the claimant from performing her sedentary occupation. They relied, in part, on the disability questionnaire which the claimant said that she used her computer to check her e-mail daily, cook meals three to four times a day, did chores, did volunteer work, and went out on her husbands boat.

Because she had a frequent and urgent need to urinate, she was unable to perform the material and substantial duties of her work.

LINA thought that the way the claimant filled out the disability questionnaire showed that she was quite active. However, in looking at the disability questionnaire she completed at the time her claim was initially granted, and the disability questionnaire at the time her disability benefits were denied there really wasn’t any change in her physical limitations.

It is important that you know how to fill out the activities of daily living form because if you don’t fill them out properly, a Long Term Disability carrier will argue that you are showing improvement in your level of functionality and that your doctors are wrong about what you can and cannot do.

Nancy Cavey, ERISA Long Term Disability denied lawyer, who handled ERISA claims in Florida, Georgia and Alabama, has written the consumer guide that all Long Term Disability applicants and recipients should read “Robbed of Your Peace of Mind.”