Three reasons long-term disability claims get denied

On Behalf of | Mar 3, 2022 | ERISA |

If you suffer from a disability that prevents you from working, the denial of a long-term disability (LTD) claim is a difficult setback to endure. Rest assured, powerful federal laws protect you and give you the right to appeal a denied claim. Here are three of the top reasons employers deny benefits to employees who are covered under LTD plans.

The medical condition is not covered

No matter how real and disabling your medical condition is, your plan may not cover it. LTD claims often face denials when:

  • The condition developed due to drug or alcohol abuse
  • The condition was preexisting

Insurance companies will generally posit a broad interpretation of “preexisting” in the context of an LTD claim denial. If you received a clear and specific diagnosis before enrolling in your plan, your condition may qualify as preexisting, but the situation is not always so cut and dried.

For instance, you may have complained about back pain to your general practitioner several months before enrolling in your plan, but were only diagnosed with a serious spinal cord disorder after you were insured. Is this a preexisting condition? Every case is unique and dependent upon the facts at hand, but the insurance company’s interpretation of your condition is certainly subject to review.

You don’t meet the definition of disabled

You may suffer from a serious physical or mental health impairment, but your employer may argue you do not meet the definition of disabled under the terms of your LTD insurance policy. In some cases, insurers will argue that the symptoms of the claimant are not as severe as reported. In others, they may argue that the claimant is healthy enough to adjust to other work. Remember, there are two sides to every story. If your medical condition is valid, you have the opportunity to prove it and appeal a denied claim.

You lack proper documentation

You must demonstrate through concrete evidence that your medical condition is severe and disabling enough to warrant LTD benefits. The documentation you need depends upon your specific condition. If you suffer from a musculoskeletal injury, you may require evidence in the form of MRI or X-ray tests. If severe depression is keeping you out of work, this documentation may consist of a note from your treating psychologist and a history of treatment and medication. An experienced legal team can help you compile the evidence you need to prove the validity of your claim.

If your employer has denied your claim, remember, you have legal options available to you. This may be just the beginning of your quest to obtain the benefits you need and deserve.


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