Long-term disability (LTD) insurance provides financial support to individuals who are unable to work for six months or longer due to serious injury, illness, or a disabling condition. People resort to filing long-term disability claims when they’re in desperate need of financial assistance, and expect insurance companies to provide them with the financial support.
Unfortunately, this whole process is far more complicated. Insurance companies don’t always handle long-term disability claims as policyholders expect. Whether you’ve purchased an individual plan or are covered under an employer-sponsored plan, there’s always a possibility that they can deny your claim. This article explores what leads to the denial of claims.
Why Insurance Companies Deny Coverage
When buying individual disability insurance, you probably started by reading brochures or plan summaries to understand how the coverage works. However, when it’s time to file a claim, the insurance company doesn’t look at those marketing materials. Instead, they carefully review the actual policy and the legal contract you signed.
They check coverage terms, exclusions, waiting periods, benefit limits, and any rules or exceptions that might limit or cancel your claim. These fine-print details can reduce your monthly payments, and sometimes even block your claim completely. In such situations, a long-term disability denial lawyer can help you understand the reasons behind the decision, identify policy loopholes, and guide you through the appeal process. The common reasons and mistakes that lead to the denial of disability claims are as follows:
- Lack of Medical Proof
Just claiming your disability is not enough. The lack of medical and vocational evidence is the main reason why appeals are often denied. You need strong documentation, such as medical records, functional capacity evaluations, or neuropsychological tests, that clearly show why you can’t work.
Statements from your treating doctors and people close to you can also strengthen your claim by confirming how your condition affects daily life. Without this level of support, your case may lack the credibility insurers are looking for.
- Skipping Initial Review
A major mistake that people make is submitting their appeal without first asking insurance companies for their long-term disability (LTD) policy and a claim file. Before filing an appeal, it’s important to review these two things:
- Review your policy: Policy is the foundation of a claim. When appealing, people should be aware of the policy because it outlines the definition of disability, what conditions must be met, and the standard required to prove. In most cases, that means showing you’re unable to carry out the core responsibilities of your job. It’s nearly impossible to build a strong appeal without knowing exactly what the policy requires.
- Review your claim file: Insurance companies use your claim file to make decisions. It includes your submitted forms, medical records, and expert reviews of insurance companies.
Missed Deadlines
To challenge a denied appeal, you have to be careful about the time-sensitive deadlines. Not submitting your appeal on time will cost you the right to pursue your benefits entirely. That’s why it’s essential to double-check the exact cutoff date for your case, because waiting too long can cost you your entire claim.
Endnote
Most of the time, things don’t go as smoothly with the insurance companies; due to their profit-driven nature, they focus on the nitty-gritty. To avoid further complications and to improve your chances of getting insurance, it is necessary to ensure you’re meeting deadlines, providing the right documentation, and reviewing each step thoroughly.
