All disability claimants dread the prospect of receiving a letter of denial, and with good reason. Most disabled people need disability benefits to support their livelihood and families; therefore, denial is a huge impediment. If you want to find out more about why some long-term disability insurance claims get denied, you are in the right place. This will help you develop strategies to ensure your application sails through successfully by avoiding the denial pitfalls.
What Is Long-Term Disability Insurance?
When you prioritize your assets, the ability to earn a living should be top on the list. Sometimes, an illness, accident, or injury may affect your functionality as an employee and lead to income loss. That, in turn, jeopardizes your finances and ability to provide for your loved ones. But long-term (LT) disability insurance offers you a safety net that protects you from income loss and its aftermath. Note that LT insurance doesn't cover injuries or accidents under worker's compensation. It only deals with injuries and maladies that are not work-related, such as a debilitating car crash or medical conditions like cancer, mental health problems, and heart diseases.
Why Are Long-Term Disability Insurance Claims Denied?
A long-term disability insurance claim can be denied for the following reasons:
1. Lack of objective findings
Objective findings refer to observations from nerve conduction studies and x-ray reports from medical examinations. These findings are outside a patient's control and include the range of motion, muscle spasms, and atrophy. If reviewers decide that you lack sufficient objective findings to support your disability insurance claim, denial is imminent.
2. Delayed filing
Most LT disability policies come with clauses providing a time frame within which a disability claimant must file a claim with their insurer. But, in most cases, it's advisable to apply for long-term disability benefits immediately after you and your physician establish that your disability is severe enough to prevent you from working. Since insurers prefer getting notified as early as possible, they will deny your claim if it's late because it contradicts the timeline in the clauses.
3. Contractual exclusion
LT disability policies contain exclusion clauses that disqualify a claimant from being eligible for benefits. For example, some insurers don't cover disabilities resulting from actively participating in riots, incidents during incarceration, acts of war, or self-inflicted injuries. They are also against policyholders that fail to observe warranted medical care requirements like attending rehabilitation. All these are grounds for long-term disability claim denial.
Receiving a letter of denial doesn't mean you are ineligible for LT disability benefits. If you feel your insurer is being unfair, you have the right to appeal the denial. At this point, you'll get better odds of winning with representation from an experienced attorney that practices disability insurance litigation. To prepare your disability insurance claim, schedule an appointment with a lawyer today, discuss the prospects of successfully appealing, and chart the way forward.