Long term disability (LTD) benefits are crucial for ensuring that you continue to receive income when you are disabled and cannot work. Your LTD claim can be denied due to missing medical records, legal technicalities, or conflicting evidence collected during your insurance company’s investigation of your claim.
1) You don’t meet your policy’s definition of disabled.
Your LTD policy will either use an “own occupation” or “any occupation” definition of disability. Under “own occupation” policies, you are considered disabled if you cannot fulfill the responsibilities of your specific occupation. Under “any occupation” policies, you are considered disabled if you can cannot perform the requirements of any occupation.
Your LTD claim may be denied if:
- You have an “any occupation” policy and your disability only prevents you from fulfilling the responsibilities of your specific occupation.
- You have an “own occupation” policy, but your insurance company used a generalized definition of your occupation that includes responsibilities that you can perform.
- You initially received benefits under an “own occupation” policy, but it transitioned to an “any occupation” policy after 24 months.
2) You have an excluded or pre-existing condition.
Some LTD policies include substance abuse disorders as an excluded condition. While not excluded, policies may also require a 12-month waiting period for pre-existing conditions.
Other reasons why your LTD claim was denied may be because:
- You submit a claim for an excluded condition.
- You submit a claim pre-existing condition prior to the 12-month waiting period.
- You submit a claim for a pre-existing condition that you failed to disclose.
3) Your insurance company is missing medical records.
Your LTD claim may be denied if your insurance company does not have all of your pertinent medical records on file, or if the records they do have do not have enough detail to adequately document your disability.
4) You have insufficient evidence documenting your disability.
Many insurance companies look for ongoing, regular treatment as evidence of your disability. Quite possibly, your LTD claim was denied if you do not have a documented history of being “under the regular care” of a physician.
5) Your claim is based on “self-reported” symptoms.
Although most LTD policies don’t require “objective medical evidence” of a disability, many insurers will still deny LTD claims if you don’t have hard records (such as MRI results or blood tests) documenting your disability. If your LTD claim is based on subjective, self-reported symptoms such as depression or fatigue, your LTD benefits may be denied.
6) Your insurance company’s doctors disagree with your physician.
Most LTD insurance companies conduct independent investigations into your disability using their own doctors and medical professionals. If one of these doctors determines that you should still be able to work after reviewing your case, your LTD claim can be denied.
7) You are caught performing activities that your disability should prevent you from doing.
In their independent investigation of your claim, insurance companies can conduct video surveillance of your daily activities. Your LTD benefits can be denied if an investigator sees you performing activities that you claim you cannot.
If your LTD claim was denied, speak to an experienced claim advisor at RightCounsel who can help get the benefits you were promised.
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