Long-term disability benefits from employer insurance can be a lifeline when you can’t work due to a serious health condition. However, getting approved for these benefits isn’t always straightforward.
Employers and insurance companies regularly deny claims, leaving you without support. Understanding the standard explanations for denial and knowing what steps to take can improve your chances of success.
Why insurance companies deny long-term disability benefits
One of the most frequent reasons for denial is failing to meet the policy’s definition of “disabled.” Each insurance policy has specific criteria; they could deny your claim if your condition doesn’t fit them.
Another common reason is having an excluded or preexisting condition. If your disability stems from a condition that existed before your coverage began or is excluded by your policy, you may face a denial.
Missing medical records or lack of documentation showing ongoing treatment can also lead to denial. Insurance companies require comprehensive evidence to support your claim. They might reject your application if they don’t see enough proof of your condition and its impact on your ability to work.
Additionally, insurance company doctors might determine that you can still work, which can lead to a denial. If they find evidence of you doing activities your disability should prevent you from doing, this could also negatively impact your claim.
What to do about it
If your claim is denied, don’t panic. First, review the denial letter carefully to understand the reasons for the denial. Sometimes, the issue is as simple as a clerical error or missing information.
Providing additional documentation or clarifying details can sometimes resolve the issue. Your doctor or hospital can assist by supplying the necessary medical records or evidence of attempts at less costly treatments.
Follow the appeals process outlined by your insurance plan. Sometimes, new information presented during the appeal can overturn many denials. Keep complete records of communications and submissions. Consistency and thoroughness are key to a successful appeal.
Seeking legal advice
If you’re struggling with the appeals process or facing repeated denials, seeking legal help might be advisable. A lawyer in disability claims can guide you and help you navigate the complexities of insurance policies. They can also represent you in negotiations with the insurance company, increasing your chances of a favorable outcome.
Understanding the common reasons for refusal and taking proactive steps in the appeals process can improve your chances of securing the necessary benefits. Don’t hesitate to seek professional legal help if the process becomes overwhelming. With the right approach and support, you can work towards a successful resolution.