Most people who purchase long-term disability insurance policies do so with the hope they will never need to use it. They also expect if the time ever comes when they need to make a claim on the policy, the insurance company will honor the policy and make payments as promised.
Unfortunately, that is not always the case. While insurance companies are clearly within their rights to deny fraudulent claims or claims that do not meet the conditions as set forth by the policy, an alarmingly high percentage of legitimate claims are denied as well. Filing a claim on a long-term disability policy is not as easy as sending in paperwork and supporting documentation.For some people, getting the compensation they are entitled to is a long, involved and exhausting process.
Understanding the most common reasons disability claims are often denied is the first step in ensuring your claim will not be one of the many that enter the appeals process or wind up in court.
Sometimes, a disability claim is denied not because of anything the claimant did or did not do, but because the insurer fails to hold up its end of the contract. You may face significant delays, be asked to submit endless copies of documentation or even face threats of policy cancellation by the insurer when you make a claim. The insurer might make a determination based on improper investigations or assumptions. In any case, when the insurer’s actions are not in accordance with the provisions of the policy, you will most likely need to engage disability insurance lawyers like the legal firm of Quadrino Schwartz to convince the company to act in good faith.
Lack of Objective Medical Evidence
When you are disabled, you know how you feel. You understand your pain and suffering better than anyone else does. Even if you have talked with your doctor and he or she understands your situation and is providing treatment without objective medical evidence, your claim could be denied. The insurance company needs to see test results, examination reports and other proof you
have a medical condition preventing you from gainful employment. Without evidence, there is a good chance your claim will be denied.
Belief You Can Still Work
Successfully making a long-term disability claim requires proving you can no longer function within your occupation. Specific policies vary in terms of what they consider your occupation; in some cases, the policy refers to the occupation you held when you became disabled while others will only pay if you cannot do any type of work.
In either case, if the insurer has any reason to believe you can perform any tasks related to your occupation, they may deny your claim. Again, work with an experienced representative who can help you navigate the claim paperwork so you can avoid inadvertently providing information that will harm your claim.
Failing to Meet Elimination Period Requirements
Most policies have an elimination, or waiting, period before you can make a claim. Most range from 30 days to six months. Making a claim before you have met that requirement is almost guaranteed to result in a denial.
Not Receiving Proper Treatment
Again, substantial objective medical evidence is often required for a successful claim. If you have not received the proper treatment for your condition, as outlined by your policy terms, your claim could be denied. For example, some insurers will not accept statements from alternative providers such as chiropractors as evidence in disability cases. Understand your policy requirements and seek the correct treatment.
Policies vary, but most long-term disability coverage does not apply to pre-existing conditions. If the insurer determines the cause of your disability was present before the date of disability (usually within 90 to 180 days), your claim will most likely be denied.
These are only the most common reasons disability insurance claims are denied. Because every case is different, there could be any number of reasons for a denial. Sometimes, it is something as simple as a missing phone number or a skipped question on the claim form. Sometimes,it is a more complex issue. In any case, understanding why many cases are denied helps you avoid the same mistakes and increase the likelihood of a favorable outcome.
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