How The Attorneys At Robinson-Warncke Help Doctors Overcome Denied Long-Term Disability Claims

Doctors dedicate their lives to caring for others, often working long hours under immense pressure. Unfortunately, even the most dedicated medical professionals can face new or prolonged health challenges that leave them unable to continue performing their medical occupation. Long-term disability (LTD) insurance is designed to provide financial support during these difficult times. However, securing these benefits isn’t always straightforward, especially once an LTD claim is denied.

The attorneys at Robinson-Warncke specialize in helping doctors navigate the complex process of appealing and overturning denied long-term disability claims. With deep expertise in disability law and a thorough understanding of the unique challenges doctors face, Robinson-Warncke provides personalized legal support to ensure that medical professionals receive the benefits they deserve.

Here’s how the team of  Atlanta Attorneys at Robinson-Warncke helps doctors overcome denied LTD claims and regain financial security.

Understanding Long-Term Disability for Doctors

Doctors often invest in long-term disability insurance as a safety net, knowing that their specialized skills are critical to their livelihoods. LTD insurance offers income replacement if a doctor becomes unable to work due to injury, illness, or other medical conditions.

• Own speciality” disability coverage: Most doctors wisely elect this type of coverage. It is the highest form of disability protection available (and the most expensive). This type of coverage provides benefits if you can’t work in your board-certified speciality, even if your medical condition would allow you to work in less demanding version of medicine.

• Own-Occupation Disability: This sounds good, but it is actually a lower form of protection. Your “occupation” is broader than your “specialty.” It typically means the field of medicine generally. So, if you are a surgeon who cannot operate, but you could work in a less demanding, non-operative branch of medicine, you would not be considered totally disabled.
• Any-Occupation Disability: This applies if a doctor cannot perform any job for which they are reasonably qualified. In other words, if you could work in an office, you would not be considered disabled.

LTD claims for doctors can be particularly complex, and insurance companies frequently deny claims for various reasons.

Why Are LTD Claims For Doctors Denied?

Doctors often face unique challenges when filing LTD claims. Insurance companies may deny claims for reasons such as:

1. Insufficient Medical Evidence: Insurers often require extensive documentation to prove a disability. Without objective medical tests or detailed physician statements, claims may be denied.
2. Policy Ambiguities: LTD policies are often filled with legal jargon and vague definitions. There is a saying in insurance, “what the large print giveth, the fine print taketh away.” For example, some policies may dispute whether a doctor’s condition qualifies as an “own-occupation” disability.
3. Misinterpretation of Disability: Insurers may argue that a doctor is still capable of working in some capacity, even if they can no longer perform their specific medical specialty.
4. Pre-existing Conditions: Claims may be denied if the insurer determines the disability stems from a preexisting condition excluded under the policy.
5. Incomplete or Incorrect Claim Documentation: Missing deadlines, incomplete forms, or minor errors in paperwork can lead to a claim denial.
6. Poor record keeping by your treaters: insurance companies use captive physicians to review the sufficiency of your medical evidence. These doctors are demanding, sometimes to the point of being unreasonable. Meanwhile, your treating providers typically don’t keep records for the purpose of documenting a disability.  They may not note every complaint you have or every abnormal finding on physical examination.  This routeinly creates problems in the claim process.

These challenges make it essential for doctors to have skilled legal representation when appealing a denied LTD claim.

How Robinson-Warncke Can Help Doctors Appeal Denied LTD Claims

The attorneys at Robinson-Warncke have extensive experience in disability law and specialize in representing medical professionals. Here’s how they help doctors successfully appeal denied LTD claims:

1. Comprehensive Policy Review

Understanding the fine print of an LTD policy is critical to building a strong appeal. Robinson-Warncke attorneys begin by thoroughly reviewing the doctor’s insurance policy to identify:

• Definitions of Disability: Whether the policy covers “own specialty”, “own-occupation” or “any-occupation” disabilities.  Even within “own speciality” policies there are subtle differences in language that can affect the outcome.
• Exclusions and Limitations: Identifying clauses insurers might use to deny claims.
• Appeal Deadlines: Ensuring all deadlines are met to keep the appeal valid.

By carefully analyzing the policy, the attorneys ensure the insurer’s denial is scrutinized and that the appeal aligns with the policy’s terms.

2. Gathering Robust Medical Evidence

Insufficient medical evidence is one of the leading reasons LTD claims are denied. Robinson-Warncke works closely with clients to gather and present compelling medical documentation, such as:

• Comprehensive Medical Records: Collecting detailed records that document the doctor’s condition, treatment history, and prognosis.
• Specialist Statements: Obtaining detailed statements from treating physicians and specialists who can explain how the condition impairs the doctor’s ability to work. These statements are often important in terms of documenting important medical findings and observations beyond what the medical records contain. Your treaters can also respond directly to an insurance medical consultant’s out-of-context observation and assertions.
• Functional Capacity Evaluations (FCEs): Coordinating independent evaluations and tests to provide objective data on the doctor’s physical limitations.
• Surveillance Counterarguments: Addressing any surveillance evidence or insurer claims suggesting the doctor is not disabled.

This evidence strengthens the appeal and makes it difficult for insurers to refute the claim.

3. Building a Strong Appeal

Appealing a denied LTD claim requires a well-organized and legally sound approach. Robinson-Warncke attorneys craft compelling appeals by:

• Addressing Insurer Arguments: Refuting the specific reasons for denial, such as lack of evidence or policy misinterpretation.
• Highlighting Policy Provisions: Pointing to sections of the policy that support the doctor’s claim for benefits.
• Presenting Expert Testimony: Collaborating with medical, vocational, and legal experts to strengthen the appeal.

By submitting a detailed, evidence-backed appeal, our attorneys maximize the chances of reversing the denial. At Robinson – Warncke our appeal success rate is upward of 90% – meaning benefits are voluntarily paid without a lawsuit ever being filed.  That means you get your full benefits sooner and at a lower cost in terms of legal fees.

4. Communicating with the Insurance Company

Insurance companies often use complex legal language and high-pressure tactics to discourage claimants. Robinson-Warncke takes over all communications with the insurer, ensuring:

• Clear and Accurate Messaging: Avoid statements insurers might use to undermine the claim.
• Negotiation Expertise: Advocating for a fair resolution during settlement discussions.
• Protecting Client Rights: Ensuring the insurer complies with all legal and contractual obligations.

This professional representation helps relieve clients of the stress of dealing directly with insurers.

5. Pursuing Legal Action if Necessary

If an appeal is unsuccessful, Robinson-Warncke attorneys are fully prepared to take legal action. For employer-sponsored LTD policies, this typically involves filing a lawsuit under the Employee Retirement Income Security Act (ERISA). We have filed hundreds of lawsuits over the years with exceptional outcomes for our clients. We have taken cases to judgment and even to federal courts of appeal. We have sued every major disability insurer. The insurers and their attorneys know that we are not a settlement mill and that we will do whatever it takes to hold them accountable for wrongful denials.

The attorneys:

• File Legal Complaints: Initiating lawsuits in federal court when insurers act in bad faith or fail to honor valid claims.
• Present Compelling Cases: Using evidence and expert testimony to advocate for the client in court.
• Negotiate Settlements: We work to secure favorable settlements whenever possible. This is often advantageous, but whether to settle is entirely the client’s decision. If the insurer will not offer reasonable value, we will always take the case to judgment. The fact that we will take cases to judgment distinguishes our firm from some heavy advertising firms, and it has a positive impact on settlement offers.

Our litigation experience and commitment to justice ensure that clients have the best chance of securing their rightful benefits.

Why Choose Robinson-Warncke for Your LTD Appeal?

Doctors face unique challenges when pursuing LTD claims, and Robinson-Warncke understands the complexities of these cases. Here’s why medical professionals trust Robinson-Warncke with their disability claims:

1. Expertise in Disability Law : Robinson-Warncke specializes in disability law, giving them an in-depth understanding of LTD policies, insurer tactics, and legal strategies.

2. Experience Representing Medical Professionals : The firm has a proven track record of successfully representing doctors and other healthcare providers, addressing the unique needs of professionals in high-stakes careers.

3. Personalized Legal Support : Robinson-Warncke provides individualized attention to each case, tailoring their approach to the client’s specific circumstances and goals.

4. Commitment to Client Success : The attorneys are committed to securing the best possible outcomes, whether through appeals, negotiations, or litigation.

5. No Upfront Fees : Robinson-Warncke typically offers a contingency fee arrangement, meaning clients don’t pay unless they win their case. This ensures access to quality legal representation without financial risk.

The Importance of Acting Quickly

When an LTD claim is denied, time is of the essence. Insurance companies often impose strict deadlines for filing appeals, and missing these deadlines can lead to forfeiture of benefits. Doctors facing a denial should contact Robinson-Warncke as soon as possible to begin building their case.

The Importance of Consulting a Lawyer Early 

Many of our physician clients consult us before they actually stop working due to illness.  By consulting us early on, we can assist you in reviewing your policy and preparing for the day you can no longer continue with your medical practice and help you avoid pitfalls in the initial claim process.

Reclaim Your Financial Security with Robinson-Warncke

For doctors, a denied long-term disability claim can feel like a devastating setback. However, with the skilled legal representation provided by Robinson-Warncke, overcoming a denial is possible. From analyzing policy language to building strong appeals and representing clients in court, Robinson-Warncke is committed to helping doctors secure the benefits they need to move forward.

If your long-term disability claim has been denied, don’t navigate the process alone. Reach out to Robinson-Warncke for a consultation and take the first step toward reclaiming your financial security and peace of mind.