What Are The Top 10 Reasons a Long Term Disability Insurance Claim is Denied?

Disability Attorneys Dell & Schaefer have handled thousands of long term disability insurance claims. Naturally we have seen a wide array of reasons by insurers for denying claims. Below are 10 of the most common reasons such claims are denied:

1. Surveillance: Insurance companies often hire private investigators to take surveillance videos of claimants to document evidence of the claimant’s ability or inability to work.

2. Online Evidence: Insurers commonly monitor claimants’ online activity and social networking accounts like Facebook.

3. Objective evidence: A lack of objective evidence or insufficient medical information.

4. Failure to meet definition of disability: The most common is when the definition of disability changes from own occupation to any occupation.

5. Policy limitations: Many disability policies contain limitations that make benefits for certain conditions payable for only limited periods of time. (Examples include disabilities due to mental illness or disabilities which are primarily based on self-reported symptoms)

6. Policy exclusions: Policies contain provisions which allow the insurer to avoid paying benefits in certain situations. One of the most common is a pre-existing condition.

7. Clerical or procedural errors: If a claimant fails to submit the required documentation in a timely manner the claim may be denied.

8. Failing to obtain appropriate treatment: If a claimant fails to see the appropriate doctor often enough the claim may be denied.

9. Compulsory medical exam: Insurer’s often require claimants to undergo medical exams by doctors hired by the insurer who find that the claimant is not disabled.

10. Improperly documented medical conditions: Claims are denied based on mistakes in the initial application and many times due to improperly documented medical conditions.

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Comments (8)

  • Kate, yes, for as long as you continue to meet the definition of disability contained in the policy.

    Stephen Jessup Apr 12, 2017  #8

  • Re Surveillance: I’ve seen cases where benefits were denied because the insured claimant was seen engaging in such activities as gardening and shopping for limited periods of time, when their occupation duties were completely different, less varied, longer lasting, and/or significantly more strenuous. I wouldn’t blame this on stupidity or greed on the part of the insurer, so much as simple lack of critical thinking.

    Michael D. Apr 11, 2017  #7

  • I was just awarded ss disability. Is my ltd company obligated to continue paying the difference from now on?

    Kate Apr 11, 2017  #6

  • Brian,

    We do not handle Social Security claims. You will need to discuss your potential claim with an attorney who does. Please feel free to contact our office if you need assistance in finding one.

    Stephen Jessup Jun 30, 2015  #5

  • 59 years old oral cancer survivor of 25 years, radiation necrosis of jaw with occasional infection and debridement surgery, area of exposed bone in mouth, radical neck surgery and mouth surgery has limited my swallowing and speech abilities with occasional choking episodes. Possible seizure activity and only one carotid which has a stent and partially occluded, frequent dizziness and confusion upon standing. My profession of 37 years requires physical labor bending and lifing, with an alarming episode of dizziness recently. My shift is 6 pm to 6 am 12 hours rotating shift. What would my chances be of permanent disability with social security dept, I feel multiple health issues and hours are making another episode imminent.

    Brian Predmore Jun 29, 2015  #4

  • In my limited experience with disability insurance carriers, the main reason claims are not paid is that they are not subject to the fair claims laws. If there is an unfair claims practice that can be used they will use it. They blame the medical professionals for lack of cooperation when they know that the medical professionals cannot send out information due to HIPPA laws.

    Theodore diMarcello Sep 17, 2014  #3

  • Cynthia,

    The standard for SSDI and private disability coverage is quite different, and a denial of an LTD benefit will not automatically prompt a denial of your SSDI. With that being said, if your LTD claim has been denied you should have the right to file an administrative appeal of the denial. Please feel free to contact our office to discuss how we may be able to assist you.

    Stephen Jessup Sep 9, 2014  #2

  • My LTD has stopped. Will I still be able to stay on my SSDI?

    Cynthia Sep 8, 2014  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Patrick J.

My experience with Dell & Schaefer began after a prolonged and frustrating experience with my disability carrier subsequent to contracting an illness which left me incapacitated. As a few examples of the frustration I am referencing: I had been accused by the ‘doctors’ appointed by my carrier to review my case as being a narcissistic fraud; the carrier sent a man to my home in the country unannounced to interview me (while I was not there but my wife and small children were); the carrier seemed to be fighting my doctor’s diagnosis and statement regarding my disability and illness; the carrier was not communicating well with me and was being cryptic with responses to legitimate questions.

I finally was so stressed from what should have been a simple process, and exhausted from the emotional and mental toll of filing a claim, that I was about to give up in the interest of maintaining what little health I had left and not wasting it fighting my carrier. I reached out to Greg Dell and he immediately set up a time to talk with Stephen Jessup and himself. I told them I just couldn’t keep managing the process – that the fight was taking its toll and I was inclined to either ‘tap out’ or quit altogether. After reviewing my case they were more than happy to drive their tank into the battle which I had been fighting with a handgun (Mr. Dell’s example). I signed with Dell & Schaefer, and suffice it to say this ‘tank’ comment seems to have been true as the very same day my carrier received the letter from Dell & Schaefer saying I had engaged their services is the same day my claim was approved.

I was curious to see how service would be after they had me contractually obligated to them. I have been impressed on this front as well. Every effort to correspond receives a response within 24 hours. Mr. Jessup is my primary contact and I have received more than one personal note from him encouraging me as I battle my illness; I believe that he really does care beyond just the financial interest the firm has in my case. On the business side of my interaction with them, I have been impressed with the thoroughness and timeliness of all responses – no matter how unimportant they might seem to Mr. Jessup. On the occasion when a question is more administrative in nature and Mr. Jessup or Mr. Dell need to defer to one of their staff, the staff is equally as timely and thorough and professional in their responses.

The stress and frustration of dealing with my carrier are gone; this benefit in and of itself is priceless. To add, I feel the benefit I gain from having Dell & Schaefer as my advocates makes their fees seem to be an excellent value.

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