10 Reasons Long-Term Disability Insurance Claims Are Denied

On Behalf of | Aug 2, 2023 | Long-Term Disability |

If you’re suffering from an injury or serious medical condition that’s keeping you out of work, you likely need the support that long-term disability insurance offers. But first, you have to have your claim approved.

Unfortunately, where there’s a will, there’s a way…for insurance companies to deny a long-term disability claim. In this post, we’ll cover some of the most common reasons that long-term disability claims are denied and what you can do about it.

1. You provided incomplete or inaccurate information

If you don’t provide all the required information or submit incomplete or inaccurate documentation, the insurance company may deny your claim.

2. You lack medical evidence

Long-term disability claims typically require extensive medical evidence to show that you’re unable to work. If the medical documentation you provide is insufficient or does not demonstrate a significant impairment preventing work, your claim is likely to be denied.

3. You have a pre-existing condition

If you have a pre-existing medical condition, you may be out of luck. Some policies won’t cover disabilities arising from a condition you had before the policy’s effective date.

4. You don’t qualify as “disabled”

Insurance policies usually have specific criteria defining what constitutes a disability and when the benefits become payable. If your condition doesn’t meet the policy’s definition of disability, your claim could be denied.

5. You didn’t wait long enough

Many long-term disability policies have a waiting period before benefits are payable. If you don’t satisfy this waiting period, your claim may be denied.

6. You didn’t follow your doctor’s orders

Insurance companies expect claimants to undergo recommended medical treatment to improve their condition and return to work if possible. Your insurance company will frown upon your claim if you fail to follow your doctor’s treatment plan.

7. You can do other work

If the insurance company determines that you can perform other types of work, even if that work isn’t the same as your previous work, your claim may be denied.

8. Your claim is excluded

Some long-term disability policies specifically exclude certain conditions or circumstances. If your injury or illness falls within these exclusions, it will be denied.

9. You filed too late

If you file beyond the deadline for filing set forth in your policy, that’s an easy reason for the insurance company to deny your claim.

10. You lied or misrepresented your claim

Never give an insurance company false or misleading information. If you do, your claim will be denied, and you’ll have a hard time obtaining any benefits for future injuries or illnesses too.

Get help with your long-term disability insurance claim

If the insurance company denies your long-term disability insurance claim, all is not lost! You may still be able to appeal.

The first step is to carefully read the claim denial letter. The letter will tell you why the insurance company denied your claim and show you what you need to do differently during an appeal.

The next step is to gather all the documents about your claim, including your medical records. Then contact the insurance company to understand what additional information it may need to reconsider your claim.

If you think the denial of your claim is unjustified, or if you need help with your appeal, reach out to an experienced disability claims attorney. Seeking legal advice can improve your chances of success.

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