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