It is fairly common for disability insurance carriers to deny a claimant his or her long term disability benefits even after a favorable Social Security decision has been made in the case. In their denial letters, LTD carriers usually state in very vague terms that the standards under the insurance policy are different from the standards used by Social Security. While the standards are different, a favorable SSDI decision is far more relevant to your case than insurance companies want you to know.
In fact, the legal standard used by the Social Security Administration to determine whether you are disabled or not is, in some instances, more rigorous than the standard contained in the disability policy.
In any event, disability insurance companies are required to consider the SSA's determination and articulate why it should not be given significant weight in your case. I submit that the standard boiler plate language that insurance companies are inserting (cut and pasting) in most denial letters, will not stand up to scrutiny at the Federal Court level of review. For example, consider the statements made by the Southern District Court of New York in a case involving UNUM:
"the fact that UNUM assisted plaintiff in obtaining disability benefits from the SSA, reaped financial benefits from this decision, and then failed to explain why it reached a disability conclusion at odds with the SSA's findings contributes to the conclusion that UNUM's determination was arbitrary and capricious." Zurndorfer v. UNUM Life Ins. Co. of Am., 2008 U.S. Dist. LEXIS 26278, *53 (S.D.N.Y. 2008).
If your long term disability carries is telling you that the favorable Social Security decision is your case does not really matter that much in your LTD claim, don't despair. Take your denial letter to a competent long term disability attorney and let him or her tell you whether the insurance company's argument can be defeated in an appeal or in a court action.
