The Most Common Reasons Disability Insurance Claims Are Denied

Disability insurance companies don’t make their money by paying claims, but by denying them; as a result, there are nearly as many reasons for disability claim denial as there are disabling conditions themselves. At Dell Disability Lawyers, we’ve seen enough of these claim denials to get a clear sense of the methods insurance companies tend to use – and at the end of the day, some clear patterns have emerged. Below, learn more about the five most common reasons disability insurance companies use to deny claims for benefits.

Disability Denial Reason #1 – Paper Review & Independent Medical Exam

The number one reason for long term disability denial is the insurance company’s paper review and independent medical exam. Your disability insurance company will have their own nurse, in-house doctor or an outside company review your medical records and determine whether you’re disabled – and since these medical providers are hired by the insurance company, they often have a vested interest in denying the claim. What’s more, this paper file review means that the physician never actually examines you before determining whether you’re too disabled to work.

As part of the file review process, the insurance company also may order an independent medical exam (IME). Though not every doctor the disability insurance company hires to examine you is a hired gun, so to speak, you still need to do research before agreeing to be examined by this doctor. If the doctor doesn’t have their own private practice and gets their income solely from the insurance company, this can be a red flag.

Click here for a more in-depth discussion about the paper review and IME.

Disability Denial Reason #2 – Change of Disability Definition and Vocational Review

The second most common reason for denying disability benefits involves the change of disability definition and the insurance company’s vocational review. Around two years after you’ve started receiving long term disability benefits, the definition of disability under your policy will change. Instead of receiving disability benefits if you’re unable to perform your own occupation, you’ll only be able to receive benefits if you’re unable to perform any occupation – and if you don’t have the medical evidence to support this heightened standard, you could find your benefits being denied.

Click here for a discussion about the disability company’s vocational review and how hiring a vocational consultant or undergoing a functional capacity exam can help you win your appeal.

Disability Benefit Denial Reason #3 – Video and Social Media Surveillance

The third most common reason for disability benefit denial involves video surveillance and social media monitoring. Unfortunately, disability claimants have next to no expectation of privacy on social media; disability insurance companies can even go so far as to create fake Facebook or Instagram profiles in order to access your friends-only posts.

But there’s no need to live in fear of video surveillance as long as you are always honest about how your disability affects you. Disability insurance companies conduct video surveillance as a way to challenge your credibility, so you should never exaggerate or overstate your symptoms or limitations. And it’s important to note that every claimant has a right to see their claim file – so if your disability claim is denied, you should always request a copy of the video surveillance.

Click here to learn more about how disability insurance companies use video surveillance and what you can do to protect your benefits.

Disability Benefit Denial Reason #4 – Your Doctor is Misled by the Disability Company

Disability insurance companies draft their own claim forms and use tactics like cold-calling your treating doctors to catch them off-guard. As soon as your doctor makes a misstep like certifying that you can perform a sedentary job or mentioning that you seemed to be improving at your most recent appointment, the disability insurance company can use this as a reason to deny your claim. It’s important for your treating doctors to be aware that the disability company may call them at any time to discuss your long term disability claim. You should always ask your doctor to call you first, and we recommend that your treating doctors ask the insurance company to submit questions in writing.

Click here to learn more about how your insurance company may try to mislead your doctor – and what to do about it.

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

The fifth most common reason for denial of disability benefits is weak medical evidence. It’s crucial to get as much objective medical proof as possible to get your long term disability claim approved, from MRIs and CT scans to blood test results or X-rays.

While there are many medical conditions that only have subjective evidence of disability, this can make proving a claim more difficult. Doctors must document everything in your records, and it’s a good idea to request a copy of your medical records after each appointment so that you can correct or change any information that’s inaccurate.

Click here to learn more about what the disability insurance company will consider when evaluating your medical evidence.

As you can see, insurance companies use many tactics to deny claims for long term disability benefits. It’s important to have an experienced legal team on your side to help you fight back for the benefits you deserve. At Dell Disability Lawyers, we’ve helped thousands of people obtain their long term disability benefits, and we can help you too. Give us a call today to schedule your free consultation.