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3 common reasons why long-term disability claims get denied

Long-term disability insurance is an important safety net. As a form of private insurance, it provides coverage for those unable to work due to crippling medical conditions.

Keen to protect their bottom line, however, insurers often find reasons to deny claims. Understanding these reasons can help you prepare a stronger application at the outset.

Here are some of the most common reasons for claim denials:

1. Inadequate evidence

Medical evidence is often at the crux of these claims. You need objective documentation of both your condition and of the limitations it causes — and how those limitations prevent you from working. Though it takes time, it’s well worth the effort to gather as much evidence as you can, including:

  • Medical records
  • X-rays and radiology reports
  • Test results
  • Medication records
  • Visit notes
  • Physical therapy evaluations
  • Occupational therapy reports
  • And any other relevant evidence

Ask your doctor to provide a detailed statement explaining the work-related limitations stemming from your condition.

Nonmedical evidence can also help support your position. Consider including statements from people who observe you on a day-to-day basis. Have them explain the limitations they perceive. The more favorable evidence you include, the better.

2. Conflicting evidence

Insurers have their own experts on hand to review claims and justify denials. These experts often conduct detailed evaluations with an eye toward pinpointing any weaknesses in your case. The best way to counteract them is to submit favorable evaluations from independent experts. A detailed vocational report from a neutral third-party can go a long way toward preventing a claim denial (or overturning it later).

Another thing to be aware of: In the course of investigating your claim, the insurance company may take a look at your social media. Photos, videos and posts that cast doubt on your condition could jeopardize your claim. For this reason, be cautious about posting to social media, especially while your application is under consideration.

3. Limiting policy language

It’s important to understand the limitations of your long-term disability insurance. These policies often contain narrow definitions of “disability.” Certain medical conditions may be expressly excluded.

You should also understand the bar you must meet in order to secure coverage. Some provide coverage when you’re unable to work in your occupation for a certain period of time. Others only extend coverage when you’re unable to work in any occupation. Misunderstanding the extent of your coverage can be a major source of headaches.

What to do after a denial

Of course, you will want to do everything you can to avoid a claim denial. However, wrongful denials are exceedingly common, and a denial isn’t necessarily the end of the road. Multiple levels of appeal may be available (provided you meet the deadlines).

Given what’s at stake, don’t attempt to navigate the process alone. An attorney experienced in long-term disability claims can help you pursue all your options.

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Alan C. Olson & Associates | 2880 S Moorland Rd | New Berlin, WI 53151
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