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What Are Some Common Reasons for Adverse Disability Determinations?

What Are Some Common Reasons for Adverse Disability Determinations?

Insurance companies typically take every opportunity to deny your claim for long-term disability benefits, but some reasons for a denial occur more frequently than others. For example, the insurance company may determine that you do not meet their policy’s disability definition. This decision often depends on whether your policy has an “own occupation” or “any occupation” definition of disability, or whether your medical conditions prevent you from doing your own occupation, or whether they prevent you from doing any occupation. If your policy has an “any occupation” definition, and you can do some work based on your background, education, and experience, then you may not meet the policy’s definition of disability.

Many long-term disability insurance policies have pre-existing condition exclusions. Therefore, if you have a pre-existing medical condition or one that existed before you had LTD coverage, you may have to wait before you can receive benefits. This waiting period can be anywhere from six to 12 months before you can receive LTD benefits for that medical condition, even if it completely disables you. Others may exclude some types of disabilities altogether, such as substance abuse disorders.

People with medical conditions based on self-reported symptoms, rather than diagnostic tests, often find it difficult to get long-term disability benefits coverage. For instance, if you suffer from migraine headaches, your doctor is likely to diagnose you with this medical condition due to the symptoms you report to the doctor, such as headaches, blurred vision, sensitivity to light, and nausea. No diagnostic lab test can definitively prove that you have migraines. Similarly, autoimmune disorders can be incredibly challenging to qualify for LTD benefits, as these conditions typically rely on tests ruling out other conditions and self-reported symptoms.

We know that you are facing disability-related legal issues that can be crucial to your future. As a result, the attorneys at Bonnici Law Group have the skills and knowledge to advise you of all potential options. We know how vital this support can be to you when you are unable to work. As a result, we are here to represent your interests throughout any dealings that you must have with your insurance company. For legal advice about your claim, please contact Bonnici Law Group at 858-261-5454 or

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Being involved in a bicycle accident can be a frightening and disorienting experience. The adrenaline rush of the collision can mask the true extent of your injuries, and the legalities involved in seeking compensation can seem overwhelming.

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