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Why are long-term disability benefits denied?

On Behalf of | Jun 30, 2021 | ERISA

For someone who suffers from a disability and is a member in good standing of an employer’s disability insurance coverage program, a denial is a stunning turn of events. By exploring some of the common reasons these claims are denied, we can begin to better understand how to overcome this difficult situation.

The claimant is not disabled

This reason for denial may be shocking because for many who are denied, their disability is real and creates a serious impediment to performing job duties. It’s more accurate to say the claimant does not meet the plan’s definition of disabled. The good news is that you have the right to appeal a denied claim. By working with an attorney who understands the complex laws that govern long-term disability benefits, you have a chance to reverse the initial decision.

Lack of documentation

It is not enough to say you are disabled based on your own self-observation. You will need documented medical evidence to support your claim. This documentation may come in the form of doctor’s notes, X-rays, MRIs and a wide range of other diagnostic tests. This is one reason it is so important to get regular treatment for your condition and to follow your doctor’s orders.

The condition isn’t covered

In some cases, disability plans exclude certain conditions. If your claim was denied for this reason, your attorney can scrutinize the original language of the contract to determine if there were any excluded conditions listed. Even there were, the legality of those exclusions may be open to scrutiny.

Whatever the reason for your long-term disability claim denial, remember, a denial is often only the beginning of the process of getting approved. Discuss your claim with an attorney who is experienced in handling claims that fall within this complex legal area.





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