Common Reasons Long-Term Disability Claims Get Denied

Long-term disability (LTD) insurance is appealing to a lot of people because of the promise of financial support when an injury prevents them from working for an extended period. However, the process of securing these benefits isn’t as straightforward as it may seem. 

You can find yourself buried in a complex web of medical evaluations, paperwork, and insurance negotiations, and the last thing you want is your LTD benefits to be denied. However, that happens more often than most people realize. In this guide, we’ll outline common reasons why your long-term disability claim may be denied. 

Inadequate Documentation

Inadequate documentation is probably the most common reason for LTD claim denials. Insurance companies require thorough evidence to support a claim, including medical records, physician statements, and treatment histories. Missing documents or poorly organized records can delay the review process or result in a denial. Your insurance company can also deny your LTD claim at the start of your application if you or your doctor fills out the application form inadequately or incorrectly. 

Be sure to maintain complete medical records, including notes from every healthcare provider involved in your care. You should also track your symptoms, treatments, and daily limitations, and follow up regularly with your providers to ensure your records remain accurate and up to date.

Fortunately, an LTD claim denial is not the end of the road. For instance, if you are a victim of Unum disability denial due to inadequate medical evidence, you can always appeal and provide the necessary documentation. 

Exclusions for Pre-Existing Conditions

Most long-term disability policies include pre-existing condition clauses. These clauses exclude coverage for conditions that existed before the policy took effect. Major carriers rely on them often to deny LTD claims. The clause can hit hard if you have a chronic illness or were in treatment before you bought the policy.

Before you file a claim, you want to read your policy’s pre-existing condition terms. If your condition is excluded, check for exceptions. You may also have other medical conditions that qualify for LTD benefits. A disability insurance attorney can help to explain your rights and your options. 

Challenges with Complex Policy Terms

Disability insurance policies are full of technical terms that can be hard to comprehend for a layman. Terms like ‘partial disability,’ ‘total disability,’ and ‘functional capacity’ can mean different things from one policy to the next. Misreading them is a common root of reasons for LTD claim denials, since the insurer applies its own definition of each term.

Read your policy slowly and in full. If the wording confuses you, it’s advisable to talk to a legal professional who specializes in disability insurance. They can explain the terms and walk you through the claims process based on your policy’s details.

Questions About Your Functional Capacity

Insurers may question how severe your disability really is. They often target your functional capacity, meaning how well you can handle daily activities or job duties. Most insurers, acting in bad faith, often lean on this argument to deny LTD claims. To build it, the insurer may order an independent medical examination (IME) or bring in vocational experts.

For best results, prepare for the IME. Give clear, detailed information on how your condition limits your work and daily life. Document your limitations, and keep a record of every difficulty you face. If need be, get your own expert evaluations to counter the insurer’s findings. Keep in mind that an IME is not always a fair, balanced process, so talk to a disability attorney early.

Endnote

The process of applying for LTD benefits can be overwhelming. You are already dealing with deteriorated physical health, and the last thing you want to do is make a mistake that will result in your claim being denied. By understanding the common reasons for denials, you can manage the process better and increase your chances of getting the benefits that you deserve.