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.