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

Attorney Victor PeñaAuthor: Attorney Victor Peña

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.

There are 8 opinions so far. Add your comment below.

Cynthia:

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

Attorney Stephen Jessup:

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.

Theodore diMarcello:

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.

Brian Predmore:

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.

Attorney Stephen Jessup:

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.

Kate:

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

Michael D.:

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.

Attorney Stephen Jessup:

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

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