Long-Term Disability Denial Basics: What You Can Do About It

11 July 2019
 Categories: Law, Blog


When you have been injured and will be out of work for an extended period of time due to your injuries, you may have opted to apply for disability benefits through your insurer. Most long-term disability policies will provide benefits after a short-term disability period expires and will pay a percentage of your previous income. However, there are some situations where your disability claim may be denied. Here are a few such situations and what you can do about them.

Policy Reasons

Sometimes, your long-term disability claim may be denied due to a conflict with your policy terminology. For example, with some disability insurance policies, there is a waiting period before you can be eligible for benefits. You must be out of work for this pre-determined period before your application will be considered.

Another common policy conflict is if the cause of your disability is not explicitly covered under the policy terms or, worse, is clearly excluded. Make sure you check your policy terms closely when you obtain the policy so that you know what is and is not covered.

Sometimes, a long-term disability attorney can fight a denial, particularly if it is because the cause of your disability not being explicitly covered in the policy language. Sometimes, sufficient evidence and similarity of your injury to something that is covered will be enough to get you approved when you get an attorney involved.

Evidentiary Reasons

Your disability insurance company will require and gather a lot of evidence in the process of reviewing your claim. That evidence must support your claim of being unable to work due to the injury. If it does not, or if there is sufficient reason to doubt it, the insurance company may deny your claim.

For example, if any of the reviewing physicians submit a report that calls into question your inability to work, the insurance company may use that as a reason for denial. Likewise, if they investigate and find evidence of you completing tasks that your injury should prevent you from doing, they can use this as evidence for denial as well. 

Not only can the evidence lead to denial, but so can a lack of evidence. Namely, if your medical records are outdated, or your doctor fails to submit those records, you may find your claim denied by the insurance company.

A long-term disability attorney can encourage your medical team to complete the records required for your application and can even provide evidence to have the insurance company review your case further and reconsider the determination.

Finally, a pre-existing condition that directly affects your injury may also lead to a denial of your claim. The reasoning for this is because the insurance company can claim that, were it not for the addition of the pre-existing condition, your injury may not prevent you from working.

Income Reasons

Sometimes, your claim isn't outright denied, but you still don't receive benefits. This typically happens because any existing income you have beyond the job you are unable to do exceeds the policy's income limitations for receiving benefits.

This is another situation where it is beneficial for you to closely read your policy language because you cannot typically fight those income limitations in an appeal. Your long-term disability attorney can review the exclusions and limitations to see if there is any way to overcome those restrictions and receive your benefits. 

The more you understand about common reasons for long-term disability denials, the easier it is to combat those denials in an appeal. Talk with a long-term disability attorney today to review your case and hopefully get the benefits that you need.