Appealing a Denial of Long Term Disability

Denial of long-term social security disability benefits is a serious problem. The insurance company may deny your claim based on a pre-existing condition that wasn’t present at the time of the accident. If this is the case, your disability attorney will need to carefully evaluate your claim to determine whether it meets the policy’s definition of disability. You should also follow the instructions of your doctor and the advice of your work site accident attorney when filing an appeal. If you don’t follow those instructions, you may face denial of long term disability benefits.

There are several reasons why an insurance company will deny your claim. Often, the insurance company will deny your claim based on contradictory evidence. For example, an insurance company may find out that you posted a picture or video on a social networking site or that you were logged into your Facebook account while on sick leave. If you believe your doctor’s opinion is valid, you can file a lawsuit against the insurance company. Here are a few reasons why an insurance company will deny your claim.

Determining the claims validity

The next step is to determine if the claim is truly invalid. The denial may be due to a lack of medical evidence or a policy term not followed. The disability must meet the definition of an impairment outlined in the insurance policy. If the claimant does not meet these standards, the insurer may deny the claim. However, if the denial is the result of bad faith on the insurer’s part, they can appeal the denial. A disability attorney can help them get their claim approved.

Considering a person’s driving history

Another reason for denials long-term disability coverage is a person’s driving history. An insurance company may reject an applicant’s application because they have multiple moving violations. Driving violations signal a high risk of serious accidents that limit an applicant’s ability to work. Reckless driving, DUIs, and excessive speeding are all examples of driving violations. Even having a driver’s licence suspended can lead to a denial of benefits. Having a five-year clean driving history will not affect your application, but having several violations in three years is problematic.

Lack of objective evidence

Denials of long-term disability benefits are often due to the lack of objective evidence supporting your claim. An insurer may claim that there is no medical evidence supporting the condition or deny the claim because the deadline was missed. Other reasons include missing policy terms or violating the insurer’s own rules. In any event, the denial of long-term disability benefits can be challenged, especially when it’s due to bad faith. A skilled attorney can help you fight back.

Exclusion clause in the contract

Another common reason for denying LTD insurance is an exclusion clause in the contract. This clause restricts an individual’s benefits because of a pre-existing condition. Insurers typically limit their benefits to “new” medical conditions. This is why it is essential to seek legal representation when filing a claim for LTD insurance. This is because there are many ways to appeal an LTD claim denial.

Regular medical care

Insurers will use an applicant’s health and lifestyle risk when determining eligibility for long-term disability coverage. If you have a mental health issue or chronic medical condition, make sure your doctor regularly visits the doctor and does a physical examination. Your medical limitations are essential for your insurance to pay. If they’re not treated properly, you may be denied the benefit. During the review period, gather the information that will support the claim.

Risk for the insurer’s policyholders

Denial of long-term disability benefits is often based on an individual’s risk for the insurer’s policyholders. The insurance company’s underwriters are not unbiased. They’re merely trying to protect their bottom line, and the insurers will not risk the safety of their clients. When a claim is denied, it is essential to know that you have a legal right to appeal and protect your rights.


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