Employer-provided long term disability policies are subject to governance by the Employee Retirement Income Security Act (ERISA). ERISA is a federal law providing for long term disability claims to be evaluated by claims administrators. These claims administrators, however, are often employed by the insurance company with which you have your long term disability policy. This means there is often a conflict of interest as claims administrators review your claim. Because of this, and other factors, long term disability claims are often denied.
Why Do Insurance Companies Deny Long Term Disability Claims?
The reasons why insurance companies deny long term disability claims range from legitimate to illegitimate. Gaining an understanding as to the reasons behind your claim denial is a solid first step in launching an appeal of your denial. Finding out the reason behind your claim denial will help you should you choose to appeal the decision at the claims administration level or even in federal court.
One of the most common reasons proffered for a denial of a long term disability claim is insufficient medical evidence. Medical evidence, or medical records, are the key to substantiating a long term disability claim. If your medical evidence is insufficient to support your long term disability claim, the insurance company will deny you benefits. Insufficient medical evidence may be due to a number of factors. For instance, you may have failed to receive regular medical treatment. Receiving regular medical treatment and providing the medical records to the insurance company is critical in order to prevail in a long term disability case.
In some cases, you may have received regular medical treatment, but missing medical records were the reason your claim was denied. If an insurance company does not receive all of your medical records, they may conclude that there were gaps in your medical treatment and deny your claim accordingly. It is always a good idea to check with your insurance carrier to see what medical records they requested and which ones they received. Help ensure that the insurer receives all necessary medical records to secure your claim is properly processed.
Even when all relevant medical records are provided, an insurance carrier may still choose to deny your claim. Sometimes, your doctor may not have clearly demonstrated in your records as to how your impairments limit your work abilities. Other times, doctors employed by the insurance company may disagree with the assessments of your treating physician.
If your medical records fail to show that you meet your insurance policy’s definition of disability, your claim will be denied. Review your policy’s definition. There are often excluded conditions listed in a policy. Some policies may require a lengthy waiting period for certain pre-existing conditions.
Insurance companies are businesses and they are looking to save money whenever they can find some sort of justification for doing so. This means that insurance companies will often employ investigators to perform surveillance on individuals making disability claims. These investigators may follow you and take pictures and video. Essentially, they are looking to catch you in the act of doing something that would be inconsistent with the disability you are claiming.
For help filing your disability claim or appealing the denial of your long term disability claim, the Disability Advocates is here for you. We work with our clients to help ensure they receive the benefits they deserve. Contact us today.