Why Do Insurance Companies Deny Claims for Disability Benefits?March 12, 2015
After an accident in which you suffer serious and permanent injuries, you may be eligible for long-term disability benefits from your insurance company (“insurer”), which provide you with a portion of your income when you become disabled. In order to assess your need for a certain benefit, your insurer will require documentation describing the injuries you have sustained as a result of the accident. Your lawyer will assist you in gathering, completing, and submitting the required documentation on time.
An insurance company may deny your long-term disability claim for a variety of reasons. Some of these might have a simple solution, such as making sure that the insurer has all of the necessary forms and documentation. In other cases, it might require the assistance of a disability lawyer to help you in your claim against the insurer in order to get the benefits that you are entitled to. For example, more complex issues may arise if you are not examined by insurance company-approved doctors, the time limitation in submitting a claim has expired, there was a misrepresentation on your application related to a pre-existing medical condition, the insurer has surveillance evidence that contradicts your claim, or there was a failure to have your injury or condition properly documented by your physician.
Generally, you will qualify for long-term disability insurance benefits if you are not able to do all, or substantially all, of the elements of your current job. A common reason that a disability insurance company will deny a long-term disability claim is for the reason that there are no “restrictions or limitations”. In short, this means your insurer has determined that the disability you are suffering from, and its associated symptoms, are not severe enough so as to prevent you from being able to work in your own job. Many long-term disability insurance policies indicate that in order to qualify for long-term disability insurance benefits, you will have to prove that not only can you not do your own job, but at some point down the road, you cannot do any job that you may be qualified to do by reason of your education, training, or experience.
Disability insurance companies often deny legitimate claims on grounds that there is a lack of objective evidence of disability and/or insufficient medical information. For instance, if the symptoms you are suffering are more subjective in nature or are “self-reported” and the insurer does not accept the claim as your symptoms cannot be proven objectively. However, the insurer’s position may be unfounded and incorrect from a legal standpoint. Perhaps you are suffering from an illness like Fibromyalgia that causes complete pain throughout your body, or from severe depression and anxiety – disorders that are more difficult to prove objectively. An insurance company will often rely upon the opinion of its own internal medical experts to decide on whether there is sufficient objective evidence of a disability. However, these professionals often only conduct a paper review and do not examine or even speak with the claimant. Even if the insurance company has initially approved your claim, they will too often cut off your benefits prematurely. This may be a result of the insurer claiming that you can work in some type of other type of job.
The insurance benefits process can be complex, with many eligible policy holders being rejected on their initial request for benefits – discouraging many people in need from obtaining the benefits they require. Utilizing the services of a disability lawyer immediately after your accident will help ensure your disability benefits claim is properly submitted and approved. A lawyer can assess your insurance policy and your injuries to collect all of the necessary documentation to strengthen your claim, such as obtaining proper medical evidence to submit to your insurer.
For more information, visit our disability lawyer section. If you have any questions, book a free consultation or call 1-855-446-7765 for immediate assistance.
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