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ERISA • Employment Law

Reasons a Disability Claim May Have Been Denied

30 Jul 2022

It is a well-known fact that disability claims through long-term disability insurance are often denied. Even when the entire appeals process is exhausted, you or your disabled loved one may be left without benefits. There are some fairly standard reasons for these denials, some of which you can avoid and some of which you can’t. In either case, working with an experienced and knowledgeable disability attorney will likely help your odds of a successful claim. 

Some of the more common reasons for an insurance company denying your claim are discussed below.

Lack of Medical Evidence

Any application for disability insurance benefits must include strong medical evidence of the disability and the ways in which it prevents the claimant from working. You will need to provide evidence from your doctor and other medical professionals that, in fact, you cannot work any longer, and that you cannot do so because of your disabling illness or injury. Remember, long-term disability benefits are for only those who are disabled based on the terms of the insurance policy. 

Failure to Follow Treatment

In order to demonstrate that your disability is preventing you from working and that you are cooperating with your medical professionals, it is critical to receive appropriate medical care and treatment for your condition. Failure to participate in your medical care program can be viewed as evidence that there is not sufficient medical proof of your disability. At the very least, the claim adjuster may state that it is not possible to decide based on the evidence you presented with your claim. 

Failure to Cooperate in Making Claim

When you are making a claim with a private long-term disability insurance company, you must respond to the inevitable requests for additional information and documentation. Even though you may consider these requests burdensome or repetitive, or simply a pain in the neck, the insurance company may deny your claim if you fail to make as complete a response as possible. Handling these requests and putting together your claim file and its attachments is one of the areas where your experienced long-term disability attorney can be most valuable for you. 

Failure to Appeal

If the insurance company denies your initial claim, it is not appropriate to simply file another claim.  Instead, you must file the complex and lengthy appeals process through its end, as dictated by the law and case law. The  cumbersome appeals process is far better handled by your experienced disability attorney than by you. Let our experienced lawyers fight with the insurer on your behalf. It is more useful to spend your time healing and learning to live your newly transformed life. 

Contact a Philadelphia Long-Term Disability Attorney Today

If an insurance company denies your disability claim, or you are struggling with filing a claim, let a Philadelphia disability attorney assist you with handling your claim. Contact us today and let us help you get the benefits you may deserve. 

Experienced Counsel

Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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