While every case is unique, there are some common reasons cited by insurance carriers when denying long-term disability benefits, including:
- No objective findings to support a claim
Medical insurance adjusters sometimes deny disability claims, alleging that the claimant never provided adequate objective findings to support their condition. This means that there are no lab results, X-rays, MRIs, hard data, or other medical tests to support the diagnosis. A denial may come your way even if the insurance policy doesn’t provide these grounds as admissible.
- Job not causing disability
A claims reviewer may deny your claim on the basis that you’re not disabled under the lower standard. Although your job may have stressful, strenuous, or unique requirements, if they do not apply industry-wide, you’re not disabled. You may still be denied coverage even if you have records from your physician stating that you’re unable to work.
- Failure to fulfill the elimination period
Most long-term disability insurance policies have a requirement that a claimant remains disabled during what is known as an “elimination period,” which typically lasts between 30 days to 6 months. A claim will be denied if the insured does not remain disabled during the entire elimination period.
Other common reasons for disability insurance denial include:
- There’s an erroneous definition of your occupation
- We’ve spoken with your doctor and he or she agrees with us
- Your records were reviewed by a doctor and he or she says you’re not disabled
- Your disability is caused by a mental condition
- Your physical limitations do not prevent you from performing substantial and material duties of your occupation
Typically, an insurance company must investigate the claim and follow applicable laws and regulations to deny coverage. This means making a good faith effort to settle the case within your policy limits, fairly dealing with your case, and disclosing conflicts. If the insurance company refuses to provide coverage for your care, you can appeal or file a lawsuit challenging the denial. Stop Health Insurance Denial works with policyholders in ensuring that they receive what they need and deserve.