Private long-term disability insurance provides you with financial stability when you are unable to work due to an injury or disability. The purpose of long-term disability insurance is to help you pay your bills and maintain your standard of living until you can go back to work.
Long-term disability insurance can be exactly what you need to help you stay financially afloat when you cannot work. Therefore, finding out that your long-term disability claim was denied can be crushing.
You have the right to appeal a denial of a long-term disability claim. Before you appeal, it is important to understand the reason for the denial.
Missing deadlines
Sometimes an appeal may not be necessary. Your claim could be denied because you missed a deadline. Timeliness is important when filing for disability insurance.
An application for long-term disability goes through many stages. Each stage has deadlines. For example, you will be asked to provide documentation to verify your injury or disability. If you do not provide the documentation by the imposed deadline, your claim will likely be denied.
Lack of documentation
Insufficient documentation is another reason claims get denied. Decisions on long-term disability claims are made after a thorough review of documentation.
Submit as much documentation as possible relevant to your injury or disability. This includes medical records, physician reports and your employment history.
The insurance company might provide you with a claim form to assist you with knowing what types of documentation to submit, but this is not guaranteed. If you do not know what type of documentation they need, ask them or have your physician submit all documentation related to your injury or disability.
Pre-existing injury
You generally cannot receive long-term disability insurance if a pre-existing injury caused or contributed to your condition. However, this is often a gray area. Sometimes your condition may involve multiple symptoms or several health conditions and pinpointing the exact cause is difficult.
Evidence from an investigation
Be prepared to be investigated as part of the claims process. The insurance company needs to confirm that you are truly injured or disabled and they employ many methods to accomplish this.
They may send an investigator to monitor your activities. This can include actions such as parking outside of your home, talking with people you know and monitoring your social media.
If the evidence they collect on your daily activities or via your social media posts does not match up with your alleged injury or disability, your claim will be denied.
The insurance company’s mistake
Sometimes your claim is denied simply because the insurance company made a mistake. The notice of your denial should contain a detailed explanation of why your claim was denied. If you have additional questions on the denial, the insurance company should provide you with a thorough explanation.
The insurance claim process is complicated. Some insurance claim representatives have more knowledge and experience than others. A representative with little experience may make an error.
There are just a few of the most common reasons long-term disability insurance claims are denied. Claims are denied for many other reasons. When you know that your claim is valid, it is important to exercise your right to appeal the denial and have guidance through the process.
