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Why Was My Long-Term Disability Claim Denied?

Long-Term Disability Insurance Companies routinely deny claims for various reasons. Here are the top 5 most frequent reasons we see, and how we can help:

  1. You or your doctor did not provide enough medical documentation. Although your insurance company will typically request your medical records and opinions from your doctors, it is ultimately your responsibility to obtain this information and provide it to them. Often times, the insurance company and its claim handlers will put in a minimal effort when it comes to obtaining your medical information. This is an easy way for insurance companies to deny your claim. You want to make sure that you follow up with the insurance company regularly on what information is still needed and/or outstanding. You may even need to go the extra step and obtain the medical records and doctor opinions yourself. How we can help: we will reach out to your medical facilities and doctors directly to request your records and opinions. We send electronic requests which are typically faster and safer, allowing us to obtain the missing medical information within days, instead of weeks. We also make personal follow ups with your doctor to ensure that the forms are being completed quickly and accurately. Thereafter, we send this information electronically and securely to your insurance company, providing them everything they need to get your claim approved.

  2. The policy's "definition of disability" has changed. Most disability insurance policies pay benefits for the first 24 months you are unable to perform the duties of your own occupation. After 24 months, the policy's "definition of disability" changes and typically, you are only eligible to receive ongoing benefits if you are found disabled from performing work in "any occupation" This stage of your disability claim if when many individuals get denied. Insurance companies see this as an opportunity to terminate your benefits and argue that you are able to work in another job that is less demanding than your previous job. How we can help: we first obtain a complete copy of your file and the doctor/vocational reports used by the insurance company. Thereafter, we reach out to your doctors for opinions and rebuttal statements, and then we conduct our own vocational assessment. Finally, we combine all of that information into a formal appeal and present it to the insurance company, arguing that you should still be entitled to disability benefits because you are not able to perform work in any occupation.

  3. Your condition no longer qualifies for benefits. Many disability insurance policies have limitations for certain conditions. These typically include mental and psychiatric impairments, or conditions like chronic fatigue, fibromyalgia, chronic pain, etc. Insurance companies place limitations on these impairments because they are "subjective" in nature, meaning they are mostly self-reported and cannot confirmed with a diagnostic test such as an x-ray or MRI. How we can help: often times, you may suffer from both mental and physical impairments. However, the insurance company may have approved you for one and not the other. In this situation, we would obtain additional medical support and evidence to support your claim and disability due to other conditions that you may qualify for.

  4. You have a pre-existing condition. When you start work for an employer and become disabled within 6-12 of starting, the insurance company will typically do a pre-existing condition review. The insurance company will usually do a "look-back period" review that is within the first 3-6 months before and after your start date. If the insurance company found that you sought medical treatment during this time, they may deny your claim due to a pre-existing condition. How we can help: you may have multiple conditions that qualify for disability. Even if you treated for a disabling condition during the look-back period, another condition may also qualify you for disability. Insurance companies often try to lump all of your conditions together; however, we work to separate each condition individually, and it may be possible that your specific condition would not be considered "pre-existing" and therefore, qualify you for benefits.

  5. The insurance company's doctor does not believe you are disabled. The insurance company routinely performs medical reviews on your claim. They may even have you attend an Independent Medical Evaluation (IME). All of these doctors are either hired by the insurance company and/or work directly for the insurance company. These doctors typically disagree with your doctors and often provide limitations that are less restrictive than those you actually have. This leads to claims getting denied. How we can help: many of these doctor reviews are inaccurate. Often times, we find missing or false information within these reports, or statements that are just out right wrong. To combat this, we reach out to your doctors, provide a copy of these reports, and ask your doctors to provide clarification and rebuttal statements. We then perform a thorough fact-checking and redline review of the insurance company's doctor's report, and point out any inconsistencies found. Hopefully leading you to getting back on claim and approved.

If you have experienced any of these situations, you should reach out to a disability attorney to discuss your options and rights. Our office continuously deals with these sorts of denials and we help individuals like you get approved.

Contact us for a free consultation today. There are never any fees and we only get paid if you get paid.

Operana Law Office | 612-568-8607


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