Disability Denial

Disability claims can be denied for various reasons, but in many cases, insurance companies may be trying to protect their bottom line rather than their policyholders’ best interests, which is known as a bad faith disability insurance denial. An experienced law firm can help you file an appeal to challenge your provider’s denial and secure the benefits you deserve. Get a free case review now to get started.

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Why Take Legal Action?

By challenging a wrongful disability insurance denial, you can pursue the benefits and justice you deserve.

Results Secured

  • $1.36 million for a New York man whose Aetna long-term disability claim and appeal were denied
  • $1.21 million for a California worker denied disability benefits
  • $975,000 for a physician who lost his hearing and was denied long-term disability benefits by Unum
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Understanding Disability Insurance Denials

Disability insurance provides financial support when illness or injury prevents a policyholder from earning a regular income.

Short-term and long-term disability policies are available through the government, employers, and private insurers. Successful disability claims can mean weekly or monthly benefits, depending on your policy.

Disability insurance is meant to help pay for any expenses that you may not be able to afford because of your inability to work

This may include:

  • Car payments
  • Debt payments (credit card bills, installment loans, student loans)
  • Housing costs (rent or mortgage payments, maintenance)
  • Living expenses (food, clothing)
  • Medical expenses
  • Utilities and taxes
  • Other expenses

Unfortunately, insurance companies are known for their high rates of denied disability insurance claims, leaving people with no financial relief when they need it most.

If you are facing a disability denial, we may be able to help. LawFirm.com works with some of the best disability denial lawyers across the nation.

Our legal partners have the experience needed to fight back against powerful insurance companies. They’ve helped policyholders recover over $127 million for wrongful disability denials.

Don’t let your insurance company deny you the benefits you’re owed. See if we can help with a free case review right now.

Types of Disability Denials

The first step to appealing your claim is determining which type of insurance provider denied disability benefits. This will allow your disability denial lawyer to prepare an appeal strategy for reconsideration.

Here is more information on the types of disability denials.

Long-Term Disability Denials

In most cases, long-term disability provides income replacement if your condition keeps you out of work after your short-term disability benefit period ends.

Did you know?

The benefit amount for long-term disability insurance could be anywhere from 60-80% of your monthly salary. Benefits can last from 5 years up to retirement.

The most common reason for disability denial is not meeting your insurer’s qualifications for long-term disability.

Because insurers could be on the hook for paying out substantial amounts of money over a long period, they often try to deny long-term disability claims.

Short-Term Disability Denials

Short-term disability covers a policyholder immediately after a serious injury or illness, typically for a period of 3-6 months.

The most common reasons for filing a short-term disability claim are:

  • Accidents
  • Injuries
  • Illnesses
  • Pregnancy/maternity leave

A medical condition must not be related to the work environment or job-related responsibilities to meet short-term disability qualifications. Otherwise, it might be covered under the employer’s workers’ compensation insurance.

One of the most common reasons for being denied disability for short-term insurance is a lack of evidence.

SSDI Denials

Social Security Disability Insurance (SSDI) is a federal program administered by the Social Security Administration (SSA) that provides financial assistance to individuals unable to work due to a long-term disability.

To be eligible for SSDI, you must meet the following criteria:

  • Have a qualifying medical condition
  • Worked a job covered by Social Security

The top reason for SSDI denials is that there is not enough medical evidence to support the claim of not being able to work. If you were denied social security disability, a lawyer may be able to help.

Long-Term Disability Insurance Companies

Dozens of companies offer long-term disability insurance, and many have been known for denying valid claims without cause.

Insurance companies with a history of long-term disability denial include:

Note: Keep in mind that this is not a complete list. If your long-term disability insurance claim was denied but your insurer isn’t listed above, LawFirm.com may still be able to help. Get started right now with a free case review.

Am I Eligible for Disability Benefits?

Eligibility for disability benefits depends on your specific disability insurance plan.

Generally speaking, policyholders must show they are unable to work to receive disability benefits.

Medical Conditions That Qualify for Disability Insurance

Medical conditions that qualify for disability insurance depend on the insurance plan and provider.

Common medical conditions that qualify include:

  • Anxiety
  • Arthritis
  • Brain injury
  • Cancer
  • Carpal tunnel syndrome
  • Crohn’s disease
  • Degenerative disc disease
  • Diabetes
  • Epilepsy
  • Fibromyalgia
  • Heart disease
  • HIV/AIDS
  • Multiple sclerosis (MS)
  • Post-traumatic stress disorder (PTSD)
  • Spine disorders
  • Stroke

If you are not sure whether your condition qualifies you to receive benefits, experienced disability denial lawyers can help.

If you are facing any type of disability denial, LawFirm.com may be able to help. Connect with us right now.

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Top 5 Reasons for Denial of Disability Benefits

Insurance companies deny claims for disability benefits for many reasons. Here are the top reasons that your claim may be denied.

1. Failure to Satisfy the Elimination Period

Most disability insurance policies have an elimination period, which is the waiting time before insurance benefits begin after a claim is made.

Elimination periods generally range from 30 days to 6 months for long-term disability policies. You must be continuously disabled throughout this period to qualify for disability benefits.

If your condition improves during the elimination period, the insurance plan administrator may believe you no longer have a qualifying health condition, even if you still can’t work.

2. Not Keeping up With Primary Care Physician Visits

Most disability insurance policies require you to receive regular medical care. As a result, you may be denied disability benefits if you stop seeing your primary care doctor or other specialists.

If you do not have health insurance, you can keep up with primary care physician visits by visiting a free clinic. You may also be eligible for reduced-cost or free Medicaid health care coverage.

3. Lack of Evidence

Insurance companies may deny your claim based on a lack of evidence. In many cases, the documentation they require is excessive, making it nearly impossible to comply with.

For example, if you developed a traumatic brain injury from a car crash, your insurer may want to see proof of how your thinking is affected and how much this limits the amount of work you can do.

A skilled disability insurance attorney can appeal a denial and resubmit your claim with documentation that establishes a qualifying medical condition.

4. Not Submitting the Claim Within the Deadline

Another reason for rejection is a missed deadline. Most insurance policies have strict deadlines for when a claim must be filed.

Typically, you must file proof of loss within 30 to 180 days after the date of the disability. However, each policy has different requirements.

If you were denied disability benefits due to a missed deadline, contact a lawyer as soon as possible to see if they can help.

5. Pre-existing Condition

Pre-existing conditions describe a medical condition that a policyholder already had before starting a new insurance plan.

Here are some common pre-existing health conditions:

  • Cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • Sleep apnea

Before the passage of the Affordable Care Act (ACA) in 2010, insurance companies could deny coverage or give coverage at inflated rates if they determined insureds had a pre-existing condition.

The ACA made it illegal for health insurance companies to deny or inflate coverage rates based on pre-existing conditions.

However, if you are enrolled in a plan that started before 2010, the insurer may deny you benefits due to a pre-existing condition.

If you have any questions about your disability denial, we may be able to help. Get a free case review right now.

Can I Appeal a Disability Denial From My Employer?

If you were denied disability benefits through your employer, you can appeal the initial disability denial.

Employee Retirement Income Security Act and Disability Benefits

Under the Employee Retirement Income Security Act (ERISA), you have several protections when filing for disability benefits.

ERISA was established to ensure employees have access to:

  • A well-established grievance and appeals process for plan benefits claims
  • Information about the minimum standards for participation, benefit accrual, and funding
  • Insurance plan features

Under ERISA, employers provide their employees with accurate and clear-cut information about plan benefits, including disability insurance. When they don’t, you can appeal the denial.

If your disability claim is subject to ERISA, you must appeal the denial promptly (which could be anywhere from 60 to 180 days). If you don’t do this, you may lose the opportunity to file an appeal.

How to Appeal a Disability Denial

Receiving a disability insurance denial can feel overwhelming. Fortunately, there are steps you can take to appeal a disability denial.

1. Investigate the Reason for the Disability Denial

The first step is to investigate why your claim was denied. Read the claim denial letter to see why you were denied and to learn the deadline for the appeal. If the insurance company didn’t send a denial letter, ask them to put the denial in writing.

Remember, insurance documents can be confusing. If you are having trouble, don’t despair.

Call our team right now at (888) 726-9160 if you have any questions about your disability denial.

2. Find a Copy of Your Disability Insurance Policy

Next, find a copy of your disability insurance policy. This document will help you and your disability denial lawyer understand the denial and potentially plan your appeal.

3. Appeal Your Disability Denial

Your disability denial lawyer can walk you through the appeal process, gather and preserve vital evidence (such as medical records and medical evidence), and handle your claim file, giving you more time to recover from your illness and injuries.

While you can appeal a disability denial on your own, working with the right disability attorney can significantly increase the chance of a successful appeal.

A trusted disability lawyer is well-versed in federal law, administrative appeals, long-term disability appeals, federal court processes, and negotiation.

When you can’t work and are denied disability, bills can add up quickly. This can increase stress during an already difficult time.

People count on disability insurance policies as a safety net because the reality is that even if you can’t work, you still have to cover your regular expenses.

If you were denied disability benefits, you don’t have to face it alone. LawFirm.com may be able to help get you the money you deserve.

Call (888) 726-9160 for a free consultation or fill out this form for a free case review right now to see if we can connect you with a top-quality disability denial attorney or law firm in your area.

Disability Denial FAQs

Why would disability insurance be denied?

A short-term or long-term disability policy can be denied for various reasons.

Here are common reasons for disability denials:

  • Claim submitted after the deadline
  • Insufficient evidence of disability’s impact
  • Missed primary care visits
  • Pre-existing conditions excluded by the plan
  • Social media contradicts reported disability
  • Total disability not proven for elimination period

If you were denied disability insurance benefits, a skilled lawyer may be able to help. Call LawFirm.com right now at (888) 726-9160 to discuss your options.

What disabilities are hard to prove?

Disabilities primarily characterized by subjective symptoms are harder to prove.

Examples of these conditions include:

  • Back injuries
  • Depression and other mental health disorders
  • Fibromyalgia

Fortunately, treating physicians can provide evidence to prove your disabilities and medical treatments.

Can you sue your insurance company for denying your disability benefits?

If you believe your insurance company has wrongfully denied your claim for long-term or short-term disability benefits, you may be eligible to take legal action.

Working with a skilled disability denial attorney is often the best and easiest way to proceed. Take the first step with a free case review right now.

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  1. Casetext. (2009, June 29). Krolnik v. Prudential Ins. Co. of Am. Retrieved November 8, 2023, from https://casetext.com/case/krolnik-v-prudential-ins-co-of-america
  2. HealthCare.gov. (n.d.) Grandfathered health plan. Retrieved November 8, 2023, from https://www.healthcare.gov/glossary/grandfathered-health-plan/
  3. Marszalek, R. & McGinley, K. (2023, May 30). What is long-term disability insurance and how does it work? Retrieved November 8, 2023, from https://www.usatoday.com/money/blueprint/insurance/long-term-disability-insurance/
  4. Mayo Clinic. (2021, October 26). Fibromyalgia. Retrieved November 8, 2023, from https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780
  5. Social Security. (n.d.) How you qualify. Retrieved November 8, 2023, from https://www.ssa.gov/benefits/disability/qualify.html
  6. Sokolove Law. (2023, October 9). Disability denial. Retrieved November 8, 2023, from https://www.sokolovelaw.com/disability-insurance-denial/
  7. U.S. Department of Labor. (n.d.) Disability insurance denial. Retrieved November 8, 2023, from https://www.dol.gov/general/topic/safety-health/disabilityins
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