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Thursday, June 13, 2024

Denied Long Term Disability Claim? 5 Common Reasons And Remedies

Claims for long-term disabilities are frequently denied. Long-term disability (LTD) insurance can help replace some of your income if you become disabled and can’t work for a long time. Long-term disability benefits are a standard benefit provided by companies to their employees.

Disability claims may be available to those who’ve been rendered unable to work due to illness or injury. Long-term disability insurance can help you financially if you become disabled due to an accident or illness that stops you from working, but there’s no assurance that your claim will be accepted. Companies often delay paying out payments under long-term disability policies to keep the premiums their employees pay into the policy. There are several potential reasons a claim could be rejected, so it’s important to be aware before filing. Visit this website to know more.

Man holding disability claim form for insurance.

Common Reasons Why Your Long-Term Disability Insurance Claim Was Denied

Having a long-term disability insurer reject your claim for disability benefits is highly frustrating. Your claim may have been denied for several typical reasons. If you have a firm grasp of these factors, you’ll have a better chance of successfully appealing the refusal and securing the benefits to which you’re entitled.

The most common causes of denied long-term disability claims are as follows:

1. Late Filing

A policy’s ‘Proof of Claim’ or ‘Notice’ clause may specify the time elapsed from the date of disability before a claim as long-term disability payments must be submitted to the insurance company for consideration. Insurance companies can reject a claim made after the policy’s deadline.

Insurance companies include these provisions in long-term disability policies because they prefer to be informed of a claim as soon as possible. An insurer’s capacity to manage a claim is hampered if received after a lengthy wait. Depending on how long you have to wait, what caused the delay, and the grounds for the delay, legal arguments can sometimes be made to successfully overturn decisions of this sort.

2. The Policy Doesn’t Cover Treatment For This Illness

Not all disabilities are covered by individual or group long-term disability insurance plans. Some policies only pay out compensation for the ailments and injuries explicitly listed. Most insurance policies have provisions called exclusions, which nullify coverage in specific situations the insurer finds unacceptable such as war, self-inflicted harm, and disability caused by criminal activity.

3. Lack Of Sufficient Evidence To Support Disability

A claim for long-term disability compensation must be supported by medical documentation. Medical evidence may include information contained in your doctor’s or health records. Insurance companies often need more information than just a diagnosis to decide whether or not a claimant is disabled under long-term disability coverage.

It’s possible that the insurance company doesn’t agree with your doctors’ assessments of your disability—and that’s why they gave you an ‘Insufficient Evidence to Support Disability’ denial. The insurance company may have asked for an in-house medical opinion on your claim, and that opinion may have concluded that your illness doesn’t warrant disability benefits.

4. There Are Inconsistencies With Your Statement Or There’s An Issue With Credibility

Insurers may also investigate, aside from medical exams, to gather evidence that disproves your claim. They may spy on your house or question your neighbors to disprove your disability claim. If they catch you being inconsistent with your statements or if they find that you have issues with your credibility, it could hurt your disability claim.

5. Failure To Meet The Deadline

At each and every stage of the claims process, a claim must be filed and all supporting documentation submitted on time. If your application is denied, note the deadline for filing an appeal. Failure to file an appeal within 180 days of receiving a refusal letter will result in losing your right to file a lawsuit against the insurer.


If Your Long-Term Disability Claim Is Denied Or Terminated, What Should You Do?

  • First, try to calm down. Many other people have been denied LTD benefits by their insurance in the same way as you have. There’s a reasonable probability that a lawyer can assist you in getting your insurer to pay for your disability if your physicians and other care providers have acknowledged that you can’t work due to your disability.
  • Second, contact a lawyer immediately if your LTD claim is rejected. The letter of denial and the most recent medical records supporting your disability will be reviewed. The lawyer will analyze these documents, talk to you about your situation, and provide advice at no cost. Don’t give up hope—there’s always something you can do.
  • Finally, keep in mind that insurance companies frequently mistakenly deny claims. Their adjusters deal with a high volume of claims and aren’t attorneys. The important thing is that you assert your rights and allow a lawyer to assist you.

To Summarize

Don’t automatically accept the insurance company’s decision to deny or terminate your claim if it has been rejected. Their decision can be challenged for various reasons. Some reasons your long-term disability claim may be denied are late filing, illness not covered by the policy, lack of evidence to support your claim, credibility issues, and failure to meet the deadline.

The objective of the insurance company is to reach the lowest feasible settlement. They’ll try everything to achieve that goal. This is why working with an attorney by your side is crucial whenever you file an insurance claim. A lawyer can assist you if you have been denied LTD coverage due to an injury or sickness.

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