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Why are long-term disability claims denied?

| Jun 23, 2021 | Long Term Disability Claim Denial

The denial of your long-term disability (LTD) claim can be a devastating setback, especially when your medical condition is severe enough to prevent you from working. There are many reasons insurance providers deny claims. Some of the most common include:

  • The claimant does not have a covered condition: Some LTD policies exclude certain medical conditions. A plan may not cover impairments related to substance abuse, for instance. In some cases, plans impose waiting periods for pre-existing conditions. These situations require a careful review of policy language to determine the exact nature of the exclusion and its legality.
  • The claimant does not meet the definition of disabled: Disabled can mean different things to different people. Your definition may not match the definition of your insurance provider. If you are unable to perform your own job duties but may be able to adjust to other work, you might not meet your plan’s definition of disabled. Rest assured, if you know you are disabled and cannot work, you have rights and the opportunity to appeal a denied claim.
  • Lack of documentation: You need documented proof of your disability to get approved for benefits. This documentation can come in the form of doctor’s notes, X-rays, MRIs, surgery records and other medical evidence. Your attorney will know which evidence is most valuable in pursuing benefits and appealing a denied claim.

An ERISA Law Attorney Can Help

Claims involving employer-provided long-term disability benefits lie within the scope of the Employee Retirement Income Security Act, or ERISA. If your claim has been denied, you should consult with an attorney who has experience handling claims that fall within this complex legal area.

Remember, a denied claim is not the end of the process. With the help of a skilled disability law attorney, you may be able to overcome your legal challenges and obtain the benefits you need and deserve.