There are many reasons a disability insurance company might deny your application for benefits.
Here is a list of 9 reasons a disability claim may have been denied. This list is not fully inclusive, but includes some of the common reasons we see. If the insurance company has closed the door on your claim, review these reasons and see if they might apply to your situation.
- You didn’t submit an attending physician statement with your application
- The elimination period hasn’t been met
- Your medical isn’t up to date or hasn’t been submitted
- The insurance company cites a pre-existing condition
- The policy language doesn’t cover what you are seeking disability benefits for
- Your other-income offsets negate your benefits
- Video surveillance obtained by the insurance company was unfavorable to your case
- Personality conflicts
- The insurance company simply doesn’t believe you are disabled
You didn’t submit an attending physician statement with your application.
- Attending Physician Statements should be completed by as many of your doctors that would be willing to support your inability to work.
The elimination period hasn’t been met.
- Your policy will state if you have an elimination period and how long it is. An elimination period is a period of time in which you must be out of work due to an injury or illness before benefits would begin.
Your medical isn’t up to date or hasn’t been submitted.
- The insurance company will often request your medical records from your doctors, but the responsibility is ultimately yours that the records are sent to them. If you can obtain a copy of your own records and send them in with a tracking number or fax confirmation, you can keep proof that they were sent.
The insurance company cites a pre-existing condition.
- A pre-existing condition can hurt your chances of filing a claim. Generally, if the insured goes for a certain time without being treated for the condition, (often a year, sometimes longer) it ceases to be pre-existing.
The policy language doesn’t cover what you are seeking disability benefits for.
- Policies can vary greatly from one to the other. An attorney experienced in disability insurance litigation can review your policy to see if benefits may be justified.
Your other-income offsets negate your benefits.
- Okay, so maybe you weren’t “denied”, but you aren’t receiving a check from the insurance company even though they agree you can’t work and qualify for benefits. Other income offsets can sometimes put a halt to receiving a check because you either make more money from your other areas of income than your disability benefits, or the insurance company is holding your checks until they are paid back on retroactive awards.
Video surveillance obtained by the insurance company was unfavorable to your case.
- Video surveillance is a tool that the insurance company sometimes uses when evaluating whether or not they believe a person is disabled. Sometimes video obtained has little to do with one’s ability to work, and sometimes video can be misleading. This is something that an attorney can argue in litigation.
- We’re all human. If you yelled at the person managing your claim, it may have influenced whether they still consider you disabled. It certainly isn’t always fair, but your livelihood can be adversely affected by negative interactions with the administrator.
The insurance company simply doesn’t believe you are disabled.
- Denial letters will often state that they have reviewed your medical and agree that you have medical conditions that may be difficult to deal with, but the insurance company doesn’t believe they rise to the level of disabling you, or their doctors disagree with your doctors.
If your claim has been denied for any of the reasons in this article, or any other reason (the denial letter will state why the insurance company is denying you), give us a call to see if we can help. Often, simply providing a response to the original denial reason is not enough.
We have successfully concluded a great many disability insurance disputes and we may be able to help you too.