6 Strong Reasons Why a Long-Term Disability Claim Might Be Denied

Long-Term Disability (LTD) coverage is given to people who became unemployed or are now unable to work because of a physical or mental injury. However, it is not as easy to get these benefits as it may seem. Many claims are denied because of reasons that could be avoided if applicants knew what went wrong or what was missing during the application process. That’s why our personal injury lawyers have compiled a list of common reasons why long-term disability claims are denied so you don’t make the same mistake when submitting your application.

Why Is a Long-Term Disability Claim Denied

Your LTD can be denied due to any of the following reasons.

1) Insufficient Evidence to Document Your Disability

To receive long-term disability benefits, you must prove that you are disabled, such that you are unable to work or get a job. In fact, a lack of objective evidence documenting your disability is one of the most common reasons why insurance companies deny claims. Certain types of illnesses such as chronic fatigue syndrome and migraines cannot be proven with diagnostic testing. Plus, if you don’t have a documented history of such illnesses under the regular care of a physician, the chances are greater that your claim will be denied.

2) Unable to Meet Your Policy’s Definition of Disabled

Many disability policies contain limitations that make benefits for some conditions payable only for a limited period. For example, the policy can either use ‘any occupation’ or ‘own occupation’ in the definition of disability. Any occupation means you will be considered disabled if you cannot perform the requirements of any occupation. Whereas own occupation definition means you will be considered disabled if you are unable to fulfill the responsibilities of your specific occupation. In that case, your claim can be denied if:

  • Your policy contains ‘own occupation’ definition but your insurance company has provided a generalized definition of your occupation which includes the tasks that you perform
  • Your policy contains ‘any occupation’ definition but your disability only prevents you from performing requirements of a specific occupation
  • You initially received benefits under ‘own occupation’ but it later transitioned to an ‘any occupation’ policy

3) Pre-Existing Medical Condition

It is harder to get your long-term disability claim accepted if you have a pre-existing medical condition (a condition the claimant was suffering from before becoming insured). This is because most policies contain clauses that exclude payment of benefits if you have a disability deemed to be pre-existing. However, some policies may require a one-year waiting period to provide benefits for pre-existing conditions.

4) Disagreement Between Your Physician and Insurance Company’s Doctor

Many LTD insurance providers conduct independent investigations with the help of a medical professional designated by them to verify your claim. If your physician determines you will not be able to work but your insurance company’s doctor disagrees, it is more likely that your disability claim will be denied.

5) Self-Reported Symptoms for Claim

To get your long-term disability claim approved, it is necessary that your medical condition is well-documented and verified by a certified medical professional. However, if your LTD claims are based on subjective, self-reported symptoms such as fatigue or depression instead of hard records such as blood tests or ECG then your benefits can be denied.

6) Misrepresentation on the Application and Human Error

It is necessary to include every aspect of your claim when filling out the application form. If you miss even a minute detail or forget to submit supplemental evidence of your disability, your claim will be denied. In fact, if you fail to disclose important medical information, the insurance company can void the policy on grounds of material misrepresentation.

How to Avoid Denial of a Long-Term Disability Claim

If you don’t want your claim to get rejected because of the above-mentioned reasons, make sure you follow these tips:

  • Keep all medical documents, reports and prescriptions and make sure these records have enough detail to adequately document your disability
  • Read your policy document thoroughly to determine whether your policy defines disability considering ‘own occupation’ or ‘any occupation’
  • Make sure you have well-documented proof of your disability, instead of claiming benefits for self-reported symptoms
  • Fill out the application form carefully and attach all required documents so there are no errors
  • Seek appropriate medical treatment right away, as the insurance company can deny your claim if you fail to do so

What to Do After the Claim Is Denied

Even if you did everything you could to file a long-term disability claim, it can still be rejected for many reasons. In this case, here is what you should do.

  • Consult a long-term disability lawyer immediately who will guide and help you fight for your rights
  • Keep the denial letter with you as it will be helpful in filing an appeal
  • If you are not sure whether you are going to appeal the decision, ask the insurance company to internally review your claim

Apart from the ones mentioned in this blog, an insurance company can deny long-term disability claims for several reasons. Irrespective of why an LTD claim was denied, you should fight for your rights and appeal the insurance company’s decision. Speak to a personal injury lawyer about your case and discuss the possibilities of getting your claim approved.