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Reasons why your long-term disability claim may be denied

On Behalf of | Oct 25, 2023 | Long-Term Disability (LTD)

Being unable to work due to an injury is a difficult situation to find yourself in. Not only are you dealing with the physical and emotional aspects of your disability, but you are also likely facing financial difficulties.

With stringent regulations for filing a disability claim, there is a likelihood that your claim may be denied. However, that doesn’t mean you will never receive benefits. Knowing why your claim was denied allows you to appeal the decision.

Lack of medical evidence

One of the most common reasons why long-term disability claims are denied is due to a lack of medical evidence. Insurers need detailed medical records to establish the validity of your claim. Having all the relevant medical records and documentation is imperative before submitting your claim. That may include doctor’s notes, diagnostic tests, treatment plan and prognosis.

A pre-existing condition

Many insurance policies have exclusions for pre-existing conditions. They may have a look-back period to see if you were treated for the same issue within a specific period before applying for coverage.

The policy’s definition of disability

Long-term disability policies often have their own definitions of what counts as a “disability.” Some consider disability to mean being unable to perform the duties of any occupation, while others consider you to be disabled if you can’t perform the duties of your current job.

Not following a treatment plan

If you fail to comply with prescribed treatments without a good reason, your insurer might deny your claim. They need to see that you’re making a reasonable effort to improve your condition.

Surveillance and online activity

Surveillance and social media can be used to refute your claim. If there is evidence of you engaging in activities that you should be unable to do because of your condition, your claim could be denied.

It’s important to remember that even if your claim is denied, you have the right to appeal the decision. You may want to discuss your situation with someone who can help you receive the benefits you deserve.