About Long-Term Disability Claim Denials
Disability insurance denials often stem from insufficient medical evidence, discrepancies in your application, or not meeting the specific criteria outlined in your insurance policy.
Whatever the reason, receiving a long-term disability (LTD) denial can be frustrating and even scary, especially when your injury or illness prevents you from working and getting a paycheck.
1 in 4 Americans will become disabled before age 65, yet most long-term disability claims are denied.
Generally, approved claims lead to monthly benefits until you recover from your disability or reach retirement or a specific age. However, in many cases, insurance companies deny valid claims to avoid paying benefits.
When this happens, you will be notified of a long-term disability denied claim through a denial letter. While this can be distressing, know that a denial can be appealed.
If you are facing a long-term disability denial and unsure what to do next, LawFirm.com may be able to help.
See if we can help get you the money you deserve with a free case review right now.
Top Reasons for Long-Term Disability Denials
Insurance companies deny LTD benefits claims for many reasons. The top reasons for denial are listed below.
1. Unfavorable Findings in Insurance Investigations
When an insurance company looks into your disability claim, they investigate it thoroughly and may use some methods that seem intrusive.
For example, they may:
- Record video surveillance footage
- Review your financial and credit history
- Scrutinize your social media accounts
- Talk with your neighbors
Remember, insurance companies seek reasons to deny you, and everything they see during their checks can greatly impact your disability claim.
For instance, if you claim to have traumatic brain injuries from your car accident that limit your ability to perform physical labor, but an investigator finds you mowing your lawn, they may dispute your disability.
Investigators may use your social media posts, such as attending your child’s birthday party, as evidence contradicting your disability claim, potentially leading to a denial.
If the investigator assigned to your claim finds anything they consider suspicious, they will report it to your insurer, which can get your long-term disability denied.
2. Independent Medical Exam Results
Your insurer may require you to get an independent medical exam (IME). An IME is a medical evaluation performed by a non-treating health care provider to assess your disability status.
Unfortunately, IMEs are known to be biased. This is because insurers often pick doctors from a list of professionals who have supported their positions in the past.
The insurer may also provide files that only include some of the policyholder’s medical records or choose a doctor who does not have the training or experience needed to evaluate a qualifying health condition properly.
This is why it is especially important to work with an experienced disability lawyer. They can guide you through the IME process and help you collect the evidence you need to build a strong case.
See if we can connect you to a top long-term disability attorney right now.
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3. Health Conditions That Can’t Be Seen
Insurance companies require concrete, objective evidence about a disability and often deny claims when this information is lacking.
Conditions with symptoms that can’t be outwardly seen are often difficult to prove. Therefore, they are more likely to be denied.
Examples of conditions that are often denied include:
- Chronic fatigue syndrome
While your condition may be backed by science, insurance companies often take advantage of loopholes, unfairly denying your legitimate claim.
4. Insurance Adjuster Mistake
Your LTD claim may be denied due to the insurance adjuster’s mistake. Insurance adjusters are often overwhelmed with claims.
While they are counted on for accuracy, they are still human and could confuse your file with another person’s, leading to a long-term disability denial.
They may also fail to review all of your documentation and assume that you don’t have enough evidence to prove your disability.
5. Lack of Documentation
Insurers make decisions based on documented evidence of a disability. Because of this, if you don’t provide enough information about your disability, they may deny your claim.
Examples of disability documentation include:
- Employment history, job descriptions, and pay stubs
- Medical evidence, drug prescriptions, and chart notes
- Physician narrative reports
- Vocational expert reports demonstrating your limitations and disability
Insurance companies place the burden of proof on policyholders and often ask for an unreasonable amount of documentation. This can be incredibly challenging, as insurers often set impossible standards for proving a disability.
If you or your doctor fail to submit the required proof of loss for your disability, it can lead to a long-term disability denial.
6. Non-Covered Health Condition
Each insurer has its own definition of a qualifying disability. Therefore, you may receive a denial of long-term disability if your condition doesn’t meet the policy’s definition of disability.
If your denial letter states that you were denied due to a non-covered health condition, talk to an experienced lawyer about appealing.
7. Not Filing Your Claim on Time
Injuries and illnesses can make it harder to meet deadlines, especially if you are hospitalized or bedridden.
However, if you don’t file your claim on time, your insurance provider will reject your claim. An experienced disability lawyer can handle your case on your behalf and ensure you meet all deadlines.
8. Pre-Existing Health Conditions
Long-term disability policies typically don’t pay benefits for conditions that are caused by or affected by a pre-existing condition.
Long-term disability policies consider a condition as “pre-existing” if you had it, received treatment, or consulted a health care provider in the months leading up to the start of your insurance coverage.
Am I Eligible for Long-Term Disability Benefits?
Generally speaking, people with severe medical conditions that affect their ability to work are eligible for LTD benefits.
Examples of LTD-qualifying conditions include:
- Heart disease
- Mental illness
- Multiple sclerosis
- Neck and back problems
- Parkinson’s disease
- Post-traumatic stress disorder (PTSD)
If you had your long-term disability denied, find out if LawFirm.com can help get you the money you’re owed. Get started with a free case review right now.
How to Appeal a Long-Term Disability Claim Denial
You can handle the appeals process on your own, but that may not be realistic when you are ill or injured. Enlisting the expertise of an experienced disability lawyer can significantly improve your chances of success.
Insurance documents are often written to be confusing. The attorneys in our network are well-equipped to collect the necessary documentation, negotiate with your insurer, and, if needed, file a lawsuit on your behalf. This relieves the stress and strain of pursuing your claim so you can focus on your health.
An appeal can be a lifeline for you and your family, ensuring you receive the financial support you need. You don’t have to face the appeals process alone.
Get Legal Help for a Long-Term Disability Denial
If you or a loved one is facing a long-term disability denial, LawFirm.com is here to help. We can connect you with a professional, experienced lawyer who can assist you in navigating the complex appeals process if you have a case.
We understand the stress and uncertainty that comes with long-term disability denials. Having someone on your side who can fight powerful insurance companies to get you the money you are owed is essential.
Get in touch with us today to see if we can help you appeal your long-term disability denial. Receiving the money you deserve will allow you to concentrate on your recovery without added stress.
Call (888) 726-9160 for a free consultation with a lawyer or law firm in our network. Our legal partners have helped recover over $125 million for people who had their long-term disability wrongfully denied. Find out if they can help you, too.
Long-Term Disability Denial FAQs
Why do people get denied long-term disability?
Here are possible reasons for your long-term disability denial:
- Disability disputed during independent medical exam
- Insufficient documentation provided (such as medical records showing disability)
- Insurance adjuster error
- Late claim filing
What percentage of long-term disability claims are denied?
Over 60% of long-term disability claims are denied for various reasons, including insurance adjuster mistakes, missing deadlines, and insufficient documentation.
An experienced long-term disability lawyer can evaluate your case and help your chances of a successful long-term disability appeal.
How do I write an appeal letter for long-term disability denial?
To write an appeal letter for a long-term denial, you must include the following:
- Contact information for you, your treating physician, and others who can validate your disability
- The insurer’s reason for denial
- New evidence supporting your medical condition
- Policy language that supports your disability claim
- Why you believe your disability claim is covered
A top-rated lawyer can help you write a strong appeal letter for your long-term disability denial claim.
Which are the worst long-term disability insurance companies?
The worst long-term disability insurance companies are those with the highest denial rates.
These companies are known for long-term disability denials: