Reasons Why Your Long-Term Disability Insurance Claim Was Denied

• September 20 2024
• |   Disability Claims

Long-term disability (LTD) insurance is a type of insurance that helps replace your income if you can’t work for a long time due to a disability. This type of disability coverage can either be provided by your employer or you can purchase it yourself.

Imagine you’re a financial officer in a company that provides long-term disability insurance to employees. You were diagnosed with an ailment that requires extensive treatment, and you will need a long time to recover. In this scenario, you can file a claim with your LTD insurer. When you find yourself unable to work due to a severe injury or illness, long-term disability insurance can be a lifeline. It can provide the financial support you need to help ease your burden.

However, the process of filing a claim can be complex, and many claimants face the frustration of denial. If you’ve recently received a denial notice, you need to understand the common reasons why long-term disability claims are denied so you can get your benefits and avoid denial.

In this blog, we will explore in detail the reasons why long-term disability claims are often denied. This will help you navigate the complexities of your policy and improve your chances of a successful claim. However, you should hire our experienced lawyers at Leverty & Associates Law to understand the claim procedure better. We can help you strengthen your case.

Why Hire Our Lawyers at Leverty & Associates Law to Help You?

At Leverty & Associates Law, we advocate for individuals struggling to obtain the disability benefits they deserve. Our experienced and highly skilled attorneys are well-versed in the intricacies of disability insurance law. We understand the tactics insurance companies use to deny claims.  Whether your insurer denied it in good or bad faith, we know how to counter denials effectively.

We understand the emotional and financial stress that comes with a disability claim denial. This is why our lawyers are dedicated to providing compassionate support. We will tirelessly advocate for and represent you throughout the claim process; you can rely on us. Contact us at (775) 322-6636 (Reno) and (702) 507-0201 (Las Vegas) to know more about how we can help you.

Even if you previously filed a claim and it was denied, give us a call; we can help you appeal it. 

Reasons Why Your Long-Term Disability Insurance Claim Was Denied

Understanding the common reasons for denial can help you navigate the disability claim process more effectively. It can also help you increase your chances of a successful appeal. Although there are countless reasons why your long-term disability claim might be denied, the following are some of the most common:

Insufficient Medical Evidence

One of the most common reasons for a long-term disability insurance denial is inadequate medical documentation. Insurance companies require detailed medical records to substantiate your claim. This includes physicians’ notes, diagnostic test results, and treatment plans. If your documentation is incomplete or does not demonstrate your condition’s severity, your claim will likely be denied.

Missed Deadlines

Insurance policies have strict deadlines for filing claims and submitting additional information. If you miss these deadlines, your claim may be automatically denied. Therefore, it is essential to know all deadlines for your claim and ensure you submit all required documentation promptly.

Non-Compliance With Treatment

Insurance companies expect you, as a claimant, to follow your doctor’s treatment plans. If you fail to comply with prescribed treatments, therapies, or medications, the insurer may argue that you are not doing everything possible to recover and may deny your claim on these grounds.

Policy’s Definition of Disability

Every policy has a specific definition of disability. Some policies require you to be unable to perform your current job, while others require you to be unable to perform any job. Noting these differences is crucial. If your condition does not meet the policy’s definition of disability, your claim will be denied. Understanding your policy’s terms is essential to ensure your claim aligns with the policy’s coverage criteria.

Pre-Existing Conditions

Most long-term disability policies exclude coverage for pre-existing conditions. Pre-existing conditions are medical conditions you had before the policy’s effective date. If your disability is linked to a pre-existing condition, the insurer may deny your claim based on this exclusion.

Lack of Evidence

Insurance companies often look for objective evidence of your disability. This evidence includes X-rays, MRIs, or blood tests. Conditions that are difficult to diagnose with objective testing, like chronic pain or mental health disorders, can be challenging to prove. Without objective evidence, your claim might be denied.

We will handle all paperwork, legal proceedings, and communications with the insurance company involved in your case, allowing you to focus on your health and recovery.

Surveillance and Social Media

Insurance companies sometimes conduct surveillance or review your social media activity to gather evidence contradicting your claim. If they find photos, videos, or posts that suggest you are more capable than your claim indicates, it can lead to a denial.

Employment Status

Your employment status at the time of your disability claim is critical. If you were not actively working or had already left your job when you became disabled, your claim might be denied. Understanding how your employment status affects your eligibility for benefits is essential.

Incomplete or Inaccurate Claim Forms

It is essential to fill out claim forms accurately and thoroughly. If you provide incomplete or inaccurate information, it can lead to delays or denials. Take the time to ensure that you completed all the forms correctly and provided all requested information.

Policy Exclusions and Limitations

Every insurance policy has exclusions and limitations that define what is and isn’t covered. Not all medical conditions are covered in disability insurance policy plans. For example, some policies limit coverage for mental health conditions, drug or alcohol abuse, or specific injuries like self-inflicted injuries and injuries sustained while committing a crime.

Reviewing your policy comprehensively can help you understand these limitations and avoid submitting claims outside your coverage.

What To Do After Your Long-Term Disability Claim Has Been Denied

Facing a denial of your long-term disability claim can be overwhelming and frustrating. However, a denial is not the end of the road. You can take steps to appeal the decision and secure the benefits you need. The following are steps to take after a denial:

Review Your Denial Letter

Carefully review the denial letter from your insurance company. The letter will outline the specific reasons why your claim was denied. You must understand these reasons; they are crucial because you must address them in your appeal.

Gather and Organize Your Documents

Collect all relevant documents related to your claim. These documents include:

• Medical records and doctor’s statements
• Diagnostic test results
• Treatment plans
• Correspondence with the insurance company
• Any additional evidence that supports your disability.

Request a Copy of Your File

You can request a complete copy of your file from the insurance company. This file contains all the information the insurer used to make their decision. Going through this file can help you identify any missing or incorrect information that needs to be addressed.

Consult With Our Attorney

Consider consulting with our attorney. We have lawyers who focus on long-term disability claims. Our experienced attorneys can provide valuable guidance, help you understand your rights, and assist in building a strong appeal.

Prepare a Strong Appeal

When preparing your appeal, ensure you address all the reasons mentioned in the denial letter. Include any additional evidence or documentation that can strengthen your case. A detailed and well-organized appeal increases your chances of a successful outcome.

Submit Your Appeal on Time

Insurance policies have strict deadlines for filing an appeal. Make sure you submit your appeal within the specified time frame to avoid automatic denial due to late submission.

Follow Up With Your Insurer

After submitting your appeal, stay in regular contact with your insurance provider. Follow up to ensure they have received all necessary documents and to check on the status of your appeal.

Consider Further Legal Action

If your appeal is denied, you may have the option to take further legal action, such as filing a lawsuit. Our attorney can advise you on the best course of action based on the specific circumstances of your case.

Has Your Long-Term Disability Insurance Policy Been Denied? Let Us Help You Appeal!

At Leverty & Associates Law, our lawyers understand the financial and physical burden of being disabled and unable to work. With a history of successful disability claim appeals, we have the expertise and experience to increase your chances of obtaining the benefits you deserve. Therefore, if your disability claim has been denied, you can count on our team of reliable lawyers.

We work on a contingency fee basis, so you don’t have to worry about paying us upfront.  Contact us today at (775) 322-6636 (Reno) and (702) 507-0201(Las Vegas) for a free initial consultation and to learn more about how we can help you.