Your long-term disability claim has significant hurdles to go through before being approved. Unfortunately, disability insurance companies have monetary reasons to look for every mistake that may exist in your claim. Especially when you are filing by yourself.
Many disability insurance claims are denied for trivial reasons that exist in the fine print. Do not go at this process alone. Insurance companies have an army of lawyers, and you do not have to be an army of one.
Below are three common reasons why your long-term disability claim might be denied.
Why long-term disability claims are denied:
1. Insufficient medical evidence
When filing for long-term disability, it’s critical to prove that your injury or illness significantly impacts your ability to work.
Insurance companies will deny your claim if you do not have sufficient medical evidence. You must have the support of one or more treating physicians, or you will not be able to prove your claim.
You generally must be seeking appropriate medical care. Many policies require the support of a treating physician who also must provide you with appropriate medical care, as defined by your policy.
For example, let’s say you have a neurological condition. If your policy contains an appropriate medical care clause, at least one of your treating physicians would need to be a neurologist. This is because it’s the specialty most suited to treat your condition. Appropriate medical care also requires regular and routine office visits with your physicians.
Regular medical appointments do not necessarily justify your disability according to your policy. You need detailed statements from medical professionals and doctors, detailing exactly how your conditions affect your work and daily activities. Your treating physician must also be willing to detail specific work restrictions and limitations while providing their opinion on your ability to work.
Do not rely on the forms from your insurance company. Insurance companies often send out attending physician’s statement forms to your treating physicians. They ask questions designed to only satisfy the minimum level of information necessary to fulfill the law and their judgment. Your physician can and should submit as much information as possible to support your claim.
To counter this insurance company approach, reach out to your doctor and other medical professionals. Ask if they will write a statement on your behalf. In some cases, medical professionals will charge an hourly rate to draft a separate medical statement.
2. Inconsistent evidence of disability
Follow your doctor’s instructions to the letter. Do not make statements to your insurer that you are more limited than you really are. Insurance companies may have a private investigator follow you to record your daily activities to determine if your claim is legitimate.
A five-minute recording can paint a different picture of your life than reality. Your daily activities should not come across as inconsistent with your medical records or statements made about your physical condition. Your benefits can be denied or your previously awarded benefits can be terminated if there is evidence that contradicts your claim.
You should not live your life in fear of being surveilled. However, you need to be aware of the reality that insurance companies will go to great lengths to deny your claim. That includes an invasion of privacy that may include video.
3. Conflicting medical assessments
Insurance companies will hire their own medical experts to determine whether you are eligible for long-term disability benefits.
They may even require you to have one or both of these tests to evaluate the impact of your disability:
- Independent Medical Examination (IME)
- Functional Capacity Evaluation (FCE)
If your insurance provider has set you up for either of these examinations, you need to talk to an attorney today. These exams will not prove your claim to the insurance company. In many cases, they use the results to prove that you do not qualify as disabled.
When two medical professionals disagree, disability claims get denied. You need to persuasively distinguish why your treating physicians’ opinions are more reliable than the insurance companies’ doctors. There are many ways to do this. An experienced long-term disability lawyer can help you determine the most persuasive way to present your case.
What to do if you’re faced with a disability denial
If your long-term disability claim has been denied by your insurance company, you have the right to file an appeal. Unfortunately, the appeals process is complex with strict deadlines, especially if you have an ERISA plan. One wrong move or missed deadline could kill any chance of receiving the benefits you deserve.
At Roy Law Group, we have been battling disability insurance cases and nothing else, since 2009. This area of the law is incredibly complicated. Let our team of experts handle everything for you. If we take on your case, you are in a winning battle.
Contact us to learn how we can help you, today.