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4 Reasons Insurance Companies Deny Long-Term Disability Claims

Long-term disability insurance is designed to give you peace of mind by providing monthly income if you become unable to work. Individuals with an employer-based disability plan expect to receive benefits if they’re needed.

However, there are often instances when insurance companies deny benefits. Some of their reasons can be legitimate, but many times they are not. Here are four common reasons insurers give for denying a claim:

1. Not Enough Medical Evidence

An insurance company may claim you haven’t provided adequate medical evidence to prove your entitlement to disability payments. As you are going through care, ask your doctor for copies of all medical records that prove you are receiving regular treatment and send copies to your insurer as you receive them. Be sure to send them in such a way that you can prove the insurer actually received them (e.g., fax or FedEx).

Proving that you are disabled is easier if you can also obtain a statement from your doctor detailing your medical condition and the restrictions and limitations it causes. Her opinion could be vital in proving your claim.

2. You Don’t Meet the Policy’s Definition of “Disability”

Disability plans define “disability” in their own unique way, and a provider may argue that your medical condition does not meet their definition. At the beginning of the claims process, obtain a copy of your disability plan and review how it defines “disability.” Integrate that definition into your claim documentaion.

3. Missed Deadlines

If you miss a single deadline as defined by your disability plan, the insurance company may deny your claim. Be sure to meet all deadlines and seek assistance with your claim if you are concerned you will be unable to meet deadlines on your own.

4. Evidence Inconsistent With the Claim

In some cases, insurers may hire investigators to follow you and obtain video surveilance of you. If the recordings are in any way inconsistent with your claim, they may deny it or terminate your benefits. It doesn’t matter if the activities you perform in the video were from a “good day” and the next day you were in agonizing pain – they will use the video of the “good day” in their arguments.

Avoid this by following your doctor’s orders for movement and activities. If you shouldn’t be lifting more than a certain weight, don’t. If he recommends using any equipment to assist with your care, do it.

Knowing how insurers deny benefits before you start the process can help you build a claim that is more likely to ensure you receive the benefits you deserve.

Client Reviews
Just when I thought there was no hope to recover my LTD benefits, I found attorney Constantin Roboostoff. With his expertise, I was able to recover all of my back long term disability benefits. Other attorneys wouldn’t take my case because it wasn’t cut and dry. Mr. Roboostoff took the challenge and did an incredible job. Not only did he get my current disability benefits going, he also recovered all my back benefits. He was a true blessing and I would recommend him whole heartedly. CW
It was my pleasure to make contact with Scott Kalkin three years ago after other lawyers had turned me away and told me I would not succeed in my lawsuit. Thanks to Scott's thoroughness, dedication, and diligence, my lawsuit WAS successful and he saw me through to the end, which included putting legal pressure on the insurance company which had invested so much time, personnel, and money, in not paying me what was due. RB
As soon as I met with Scott, I could tell he was knowledgeable, resourceful, experienced, highly professional, and would be dedicated to getting me fair treatment. Scott has handled all interactions with my insurance company ever since. Being able to rely on him to represent me has been a huge relief for a chronically ill person. SO