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Insurance companies routinely deny claims for long-term disability benefits, even when a claim is legitimate and the application is completed correctly.
If your LTD claim was denied, it’s important not to give up your claim.
Most insurance companies will not approve an LTD claim or pay benefits until you hire a long-term disability lawyer.
Insurance companies are in business to make money, and denying claims helps them do that.
A disability lawyer uses the law to keep insurance companies honest and make them pay legitimate claims.
These are some of the most common reasons for an LTD denial and what they mean.
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Late Application Filing
The insurance policy will usually have a time limit on how long you have to file a claim.
That time limit begins when you first become aware of your disability.
Even if you filed your claim before the limit expired, insurance companies sometimes use this clause to deny the claim by stating that based on your application, you knew, or ought to have known, about your disability before the date you entered on the application.
No Medical Evidence That Proves a “Total Disability”
To be eligible for LTD benefits, your condition must prevent you from being able to perform the essential duties of your work. This is known as “total disability.”
The insurance company may feel that:
- Your symptoms, as stated in the application didn’t properly demonstrate that you are ‘totally disabled’ from completing your duties at work
- That an assessment by their consultant disputes the claims made by you and your doctor in the application
- There wasn’t any evidence or enough evidence to prove your medical condition.
A lack of medical evidence is commonly used by insurance companies to deny LTD claims for medical conditions that can’t be shown by an x-ray, MRI, blood test, etc., that are called “invisible injuries.”
Many long-recognized medical conditions fall into that category, including:
- Anxiety
- Arthritis
- Chronic pain
- Depression
- Fibromyalgia
- Post-Traumatic Stress Disorder (PTSD)
- Soft tissue injuries
- Traumatic brain injuries (TBI)
- Whiplash
- Chronic fatigue
Pre-Existing Condition
The insurance company may use a pre-existing condition clause to deny your claim.
They may take the position that your disability began before you came under the policy by pointing to a previous condition in your medical history.
Or the insurance company may state that you are ineligible for benefits because you didn’t disclose a previous medical condition on the initial insurance application you submitted to join your work’s benefits plan.
Not Complying with the Insurance Policy Requirements
The insurance policy may ask you to be assessed by one of their representatives in regards to your claim in what’s called an “independent medical examination (IME).”
They may ask you to attend a few examinations, and if you miss one or fail to provide them with information they ask for, they will likely deny your claim.
The IME is performed by a doctor of their choosing and will likely contradict or downplay your own medical professional’s assessment.
You Are No Longer Meet the Definition of Totally Disabled
If you’ve already been receiving LTD benefits, the insurance company may send you a letter telling you that they intend to stop your benefits by claiming that you are no longer disabled.
They may use the information they receive during an IME to make that decision.
This typically happens around two years after someone has been receiving LTD benefits.
That’s the time when the definition of total disability changes in the policy from not being able to perform the tasks of your “own occupation” to not being able to perform the tasks of “any occupation” – a job that you could reasonably perform with training.
If any of the above happens to you when applying for or receiving disability benefits, contact a long-term disability lawyer for more information on your rights.
