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Long Term disability claims are often denied or terminated for reasons that are not immediately clear. Some of the most common reasons include insufficient medical documentation, missed deadlines, lack of objective evidence, policy exclusions, or an insurance company’s determination that your condition does not meet the policy’s definition of disability.
If your Long Term disability claim was denied or your benefits were terminated, you may have been told that you can return to work or that your condition no longer meets the policy definition of disability. In many cases, that conclusion is based on how the claim was interpreted rather than the full reality of your condition.
At Osterhout Berger Daley, we regularly work with individuals and attorneys to appeal Long Term disability denials and restore terminated benefits.
Why Long Term Disability Claims Are Denied or Terminated
Many claimants assume that a diagnosis and ongoing treatment are enough to secure or maintain benefits. In practice, that is not how these claims are evaluated.
Insurance companies focus on how your condition affects your ability to work on a consistent basis. If your medical records do not clearly explain your limitations, or if your condition is evaluated based on assumptions rather than real-world impact, your claim may be denied, or your benefits may be terminated.
This is one of the most common reasons people search for help after receiving a denial letter.
How OBD Appeals Long Term Disability Denials
At OBD, our approach focuses on correcting how the claim was evaluated.
This typically involves developing the administrative record to clearly show how your condition affects your ability to work over time, not just in isolated moments.
We focus on:
* Demonstrating functional limitations, not just diagnosis
* Addressing assumptions about work capacity
* Connecting medical evidence directly to policy requirements
* Showing whether work can be sustained on a full-time basis
This is often what changes the outcome of a claim.
Case Example: New York Life Reinstates LTD Benefits After Appeal
In a New York Life case, the claimant, who had spinal pathology, radiculopathy, chronic pain, and cognitive difficulties, was initially approved for benefits which were later terminated by the insurer.
The insurer determined that the claimant could perform sedentary work.
OBD responded by developing the record through a Functional Capacity Evaluation, updating medical records, and gathering opinions from treating physicians. This documentation demonstrated limitations below sedentary work, including reduced sitting tolerance, the necessity for frequent breaks, and an inability to maintain consistent attendance.
Upon review, New York Life reinstated the claimant’s Long Term disability benefits.
Case Example: Unum Reverses LTD Denial After Record Development
In a Unum case, the claimant, diagnosed with spinal stenosis, neuropathic pain, and gait disturbance, was denied Long Term disability benefits.
The denial was based on reviewers’ descriptions of the condition as “mild,” and their finding that the claimant was fit to return to work.
OBD developed the record by obtaining updated imaging, compiling longitudinal treatment records, and securing an independent examination. The evidence established limited sitting tolerance, reduced endurance, and functional limitations incompatible with sustained work.
After considering this evidence, Unum reversed the denial of benefits.
Case Example: Lincoln Financial Reinstates LTD Benefits After Termination
In a Lincoln Financial case, the claimant’s benefits were terminated after the insurer concluded the claimant had recovered from Guillain-Barré syndrome.
Despite this determination, the claimant continued to experience post-infectious fatigue, visual instability, and significant difficulty sustaining computer-based work.
OBD worked with treating providers and used medical documentation to show that the claimant could not sustain work activity throughout the day.
Upon review, Lincoln Financial reinstated the claimant’s Long Term disability benefits.
Can Long Term Disability Benefits Be Reinstated After Termination?
Yes. Benefits can often be reinstated after termination if it is clearly demonstrated with supporting evidence that your condition still prevents you from sustaining work. Reinstatement typically occurs when the full claim record shows that functional limitations persist. However, reinstatement is less likely if there is no new medical evidence or if the documentation does not clearly establish ongoing limitations. If the insurer’s decision is supported by strong evidence that you have improved or recovered, or if appeals deadlines have passed, the chances of reinstatement may also be reduced. Being aware of these factors can help claimants have a realistic understanding of potential outcomes.
Many terminations are based on assumptions about improvement rather than a full evaluation of functional capacity. When those assumptions are challenged with clear evidence, outcomes can change.
What to Do If Your Disability Claim Was Denied or Terminated
If your Long Term disability claim was denied or your benefits were terminated, you are not alone.
Many claims are successfully resolved on appeal when the record is properly developed, and the claim is presented in a way that reflects the full impact of the condition.
At Osterhout Berger Daley, we help individuals and attorneys nationwide navigate Long Term disability appeals and ERISA claims.
Frequently Asked Questions About Long Term Disability Denials and Terminations
What should I do after my LTD claim is denied or terminated?
You should review the denial letter carefully and understand the reason for the decision. In many cases, the next step is to file an appeal and develop the record to clearly show how your condition limits your ability to work.
How long does a Long Term disability appeal take?
Timelines can vary by policy and insurer, but appeals are typically reviewed within a set period defined by ERISA guidelines. On average, most Long Term disability appeals take between 3 to 6 months to be processed. The process may be shorter or longer depending on the complexity of the case and whether additional documentation is requested.
Can all disability claims be reinstated after termination?
Not every case results in reinstatement, but many claims can be successfully resolved when the record is fully developed and clearly demonstrates ongoing functional limitations.
What kind of support does OBD provide during an appeal?
OBD works with clients to review the claim, develop the administrative record, gather supporting medical evidence, and address the reasoning used in the denial or termination. Throughout the appeal process, we provide ongoing support by regularly updating clients on case progress, answering any questions, and assisting with paperwork and documentation. Our team is available to guide clients at each stage, so they feel informed and supported from start to finish.
What to Do If Your Disability Claim Was Denied or Terminated
If your claim has been denied or your benefits have been terminated, we can help you understand your options.
Contact Osterhout Berger Daley to discuss your case. We offer a free initial consultation so you can understand your options with no upfront cost.
Contact our team for a free case evaluation. We’re ready to help.