Who decides if I am disabled?

Unfortunately, the long-term disability insurance company makes the decision on whether or not you are disabled. They have this power because the United States Supreme Court has ruled that the insurance company can reserve to itself the discretion to make such decisions. After the ruling, all long-term disability insurance companies reserved the power to themselves.

Thus, even though you may have a favorable doctor’s opinion, or several, and other supporting documentation, do not be surprised to receive a denial. Why? In the face of such documentation, the long-term disability insurer will often have their internal company doctors, or their own consulting doctors, render an opinion on whether or not you can work with your ailment or whether or not you are truly suffering from your ailment. In the insurer’s discretion, they can decide to rely on this one opinion from a doctor who never treated or examined you and deny your claim.