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Common Reasons for Denials in Long-Term Disability Cases

Common Reasons for Denials in Long-Term Disability Cases

Since the terms of various long-term disability plans can differ widely, there are many different reasons why an insurance company might deny benefits to applicants. However, there are some reasons that are more common than others when it comes to insurance companies denying claims for long-term disability benefits. Some of these reasons are as follows:

  • Exclusion of Preexisting Conditions – Many plans place limitations on disability claims related to preexisting medical conditions, which are often defined as conditions for which you sought medical treatment within a certain number of months prior to coverage beginning. After a certain period of employment, prohibitions on benefits for preexisting conditions may expire, in which case the claimants may be entitled to benefits for the preexisting conditions.
  • Lack of Objective Evidence or Reliance on Self-Reported Symptoms – Some plans require objective evidence of disabling medical conditions, such as evidence shown by X-rays, MRIs, blood tests, and other test results. If a medical condition is documented largely through self-reported symptoms that cannot necessarily be tested, such as headaches, nausea, dizziness, and fatigue, the insurer may attempt to deny coverage based on a lack of objective documentation of the conditions.
  • Failure to Seek Appropriate Treatment or Medical Care – Long-term disability benefits may be conditioned on evidence that the applicants are currently under the care of a physical or other medical professional and actively receiving appropriate treatment for the disabling medical conditions.
  • Elimination or Waiting Period Not Fulfilled – Many insurance plans provide for a elimination or waiting period of continual disability before individuals become eligible for long-term disability benefits. In some cases, the period may be as much as six months or the length of time for which short-term disability benefits are available.

Insurance companies often deny initial long-term disability claims, even when you are clearly entitled to benefits. Bonnici Law Group has the experience and knowledge that you need as you seek compensation for your injuries and struggle to recover from them, both physically and emotionally. We know how to help you create and maintain a strong claim for relief supported by the evidence and obtain the best outcome possible in your case. Do not hesitate to contact Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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