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Reasons Long-Term Disability Benefits Can Be Denied

Posted by on Jun 9, 2017 in Long-Term Disability | 0 comments

Long term disability due either to illness or injury can have a devastating effect on the financial life of a struggling family. Quite too often the disability benefit applied for by many individuals get turned down by their insurance provider. The usual reason for such denial is strictly technical, though, and not because of ineligibility. Technical reason may be improper filing of an application, missing a signature or skipping a box when filling out a claims form – these errors often happen because disability insurance policies are long and complex documents that many applicants find confusing.

However, there are also reported instances when applicants are judged not qualified or, if approved, are awarded small payments. If long term benefits are meant to compensate for salary losses, then even being awarded a small amount would never suffice for medical treatment, much more to support a family’s daily needs.

Many insurance providers resort to finding faults in applications aggressively and then deny claims or award small benefits to ensure increase in their profit. Besides using the guise of technical or paperwork issues, these providers also resort to other tactics to make denials appear legitimate, tactics like, misclassification of injuries, undue termination of a policy or delay in the approval and/or release of cash benefits.

Legal experts call denials of benefit as “insurance bad faith,” which is a breach of the contract that providers, themselves, made and signed with the policy holder. If an insurance company, though, denies any long term disability benefits claim, then the applicant must be allowed to a full and fair examination of the denied claim, as well as to appeal the decision.

An appeal is a formal petition that asks for a re-assessment of an unfavorable decision (like a denial, termination or reduction of benefits) made by an insurer.

According to a long-term disability claim lawyer, the usual reasons why long-term disability benefits can be denied include:

  • Inadequate Medical Support: Medical records can help prove how severe your injury or disability is, as well as the impact on your ability to work. If your claim is missing important information, the insurance company may deny your claim due to a lack of evidence.
  • Definition of Disability: Each long-term insurance policy may have a unique disability definition. Some policies have guidelines which are much stricter than others, and certain medical conditions may even be excluded. It’s important to understand what your policy allows, and what criteria must be met in order to qualify.
  • Social Media Investigation: Insurance companies can also deny your claim if they find examples of behavior where you appear to be able to perform activities despite your illness or injury. A common source used by the insurance companies includes searching your social media accounts to show that your condition is not as limiting as you claim.

If you have been denied your long-term disability benefits, you owe it to yourself and your family to get the legal advice you need to ensure your appeal is accepted. A long-term disability lawyer knows what it takes and he/she may be able to help you understand your legal options.

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