Why Long-Term Disability Applications Get Denied

Tucker Law Group
December 13, 2019

If you are disabled and unable to work, long-term disability benefits can be crucial to your future. Long-term disability (LTD) benefits allow you to receive income, even after a disability prevents you from working. This income ensures that you can financially provide for yourself and your loved ones.

Unfortunately, many disability applicants receive long-term insurance disability denials.

Common Reasons for a Long-Term Disability Application Denial

There are many reasons for denials, including:

  • You do not meet the definition of disabled, according to your LTD policy. Typically, workers receive a label of disabled when they are no longer able to perform their job duties. Your policy may state that to qualify for long-term disability insurance benefits, you must no longer be able to perform job duties for “any occupation.” This is different from being unable to perform your specific job duties.
  • You have a pre-existing condition or an excluded condition. Many LTD policies exclude substance abuse disorders, as well as certain other conditions. Many pre-existing conditions require a 12-month waiting period before approval.
  • Your insurance company is missing medical records. The insurance company may not have your medical records. They may also not have records that accurately document your current disease, illness, or injury that keeps you from working.
  • You cannot produce medical evidence to document your disability. It is important that you have documentation of regular medical treatment. It is also important that your medical records are complete. A statement from your physician that details your work-related medical limitations may help your case.
  • You filed an LTD claim based only on your self-reported symptoms. You will have a hard time getting long-term disability benefits without corroborating evidence from a physician. This evidence may include blood tests, X-rays, MRIs, and other tests that document your disability. Conditions based on subjective complaints are also likely to receive a denial. Fatigue and depression are examples of subjective complaints.
  • The insurance company’s physicians disagree. In some cases, the insurance company’s doctors disagree with your physician. They may not agree on whether your medical condition renders you disabled.
  • You engaged in certain activities. The insurance company may find evidence that you engaged in activities beyond your disability. They often use this evidence to deny claims.

ERISA Governs Long-Term Disability

ERISA, a federal law that stands for the Employment Retirement Income Security Act, governs long-term disability policies. The law allows a claims administrator, who often works for the insurance company, to look at your application.

As you might imagine, this is an inherent conflict of interest. When the insurance company’s employee is the first person to make a determination about your LTD, you need an attorney on your side. Claims administrators routinely deny LTD claims, even when there is clear evidence of a disability. Most individual disability insurance plans and all group plans governed by ERISA allow 180 days to appeal an initial denial of LTD benefits.

Contact Our Attorneys for Help with Your Long-Term Disability Denial

When filing a long term disability claim, you may find your claim denied, even without a good reason. If you receive a claim denial, then we can help. Call our experienced long-term disability insurance attorneys at Tucker Law Group today.

You can fill out our confidential contact form or call us at (866) 233-5044 for a free consultation and review of your potential case. We can discuss your rights to appeal.