Question
How can I mount a successful appeal to a denial of coverage under my employer's Insurance carriers EOI review for Long Term Disability. Or is it a losing battle?
I recently returned to work in May from a 22 month long term disability claim (pancreatic cancer surgery and chemo). In total remission for 15 months. Upon my return, I signed up for my employer's benefits package including optional long term disability and life insurance coverage. I was given a survey to determine evidence of insurability. I was denied not for my previous cancer, but for answering I had sleep apnea (which I have been treating with a prescribed custom mouth guard for many years), and also answering that I've spent more than 10 consecutive days on LTD in the past. The insurance company says they will send me documentation for their appeal process. I'm concerned since I've just found out I need a biopsy for nodules found recently after being in total remission for 15 months. Am I out of luck if things take a turn for the worse and need another long term leave to seek treatment? Your opinion?
Answer
I don’t think you will have too many options as your Employer is not required to offer Long-Term Disability insurance and the disability insurance company has the right to determine if they want to offer you the coverage. You situation is not favorable for coverage because you stated that the LTD coverage is optional, which means that it's not a true group disability policy offered to all employees. Regardless, you should appeal their denial of coverage.
