A disability could severely impact your life and ability to work. You may be qualified for long-term disability (LTD) benefits, which can cover medical expenses, lost wages and other financial matters.
There are many reasons why an LTD claim may be denied, which can be annoying and stressful. By understanding the reasons for an LTD claim denial, you may be able to present a strong case to appeal the decision. Here are a few causes of denials:
Missing documentation
When making an LTD claim, it’s important to have all of the right documentation. One such document is proof that you received regular medical attention from your specialist or primary care physician for your disability. It’s also necessary to see the correct physician for a medical condition, such as a psychiatrist for a cognitive condition. These visits should be made at routine intervals. Additional documentation may include tests given to you by your doctor, such as x-rays, MRIs or CT scans and statements from your doctor. Insufficient medical evidence may lead to an LTD denial.
Bad faith insurance
An LTD claim denial may not have been your fault. An insurer may have rejected your claim out of bad faith. This can happen if an insurance company refuses to pay a claim without reason or fails to investigate a claim.
Missed deadlines
You have a deadline you must meet to file a successful LTD claim. A claim typically needs to be submitted within one or two months from the date of a disabling event. Missing this deadline could lead to a denial.
Uncovered medical condition
An LTD insurance policy will typically define when a medical condition is “disabling.” Typically a disability is any kind of medical condition that prevents someone from performing their occupational duties. A disability caused by substance abuse or a pre-existing condition isn’t often covered. If a medical condition is not considered disabling, then a claim may be denied.
Appealing an LTD denial isn’t always easy. You may need to reach out for help as you explore your legal options.
