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Why long-term disability claims are denied

The Employee Retirement Income Security Act (ERISA), which became law in 1974, allows those who become disabled and unable to work to receive long-term benefits. However, applying for these benefits is a complex process, and there are countless reasons why such benefits are denied.

What are some common reasons why claims are denied, and what can be done to avoid these mistakes?

Failure to meet the requirements

There is no single definition of “disabled.” Each insurance company has its own criteria – even different policies have different requirements – and if these are not met, the claim will likely be denied. Some policies define disability as the inability to work at your particular job, while others require that you are unable to work at any job. And “long-term” may be defined differently as well. Preexisting or excluded conditions (such as those caused by substance abuse) can also lead to a claim being denied.

Before filing a claim, read your policy carefully to see if you meet the criteria. Failure to meet the requirements is the most common reason for denial of long-term disability benefits.

Lack of sufficient medical documentation

It’s not enough for you to believe that you meet the criteria; you need to convince the insurance company that you do. In order to do this, you’ll need proper documentation from qualified healthcare providers. This could include records related to X-rays, MRIs, CT scans, blood test results, medication, letters and forms from doctors, and information about any treatment you are currently receiving. If your claim is related to an accident, written statements from witnesses are important. All health-related documents and third-party testimony should be kept and carefully organized.

Disability claim does not match video surveillance or social media

Make no mistake, insurance companies will leave no stone unturned to reveal an inconsistency in your claim. An investigator may shadow you and video your activities, and your social media accounts may be checked as well. If you engage in activities that seem to contradict your claims – something as simple as carrying in bags from your car or doing light home or yard maintenance – the insurance company will not hesitate to deny your claim.

Be honest about the degree of your disability. Neither understate nor overstate what you can’t do. In your day-to-day activities, act in a way that is consistent with those claims. And follow your doctor’s instructions; if you have specific restrictions, observe them carefully.

Failure to submit paperwork on time

Both insurance policies and laws contain limits regarding both the time you are allowed to file after you become disabled and the time given to file an appeal if your initial claim is denied. Pay attention to deadlines and time limits. Read the small print, and do your research. Additionally, medical documentation should be submitted well ahead of time, as it won’t be allowed as evidence if you wait until you are in court.

Insurance companies look for any reason to deny a claim, and they are experts at knowing exactly where to find them. When filing for long-term disability benefits, don’t try to negotiate this complex process on your own. It is best to consult a qualified and experienced attorney.

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The Law Office of Jessica Taylor, PLLC

The Law Office of Jessica Taylor, PLLC
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Phone: 210-265-6759
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