Why Was My Long-Term Disability Claim Denied?
Being injured and unable to work is a frightening experience compounded by the denial of a long-term disability claim. A claim may be denied for various reasons, requiring you to appeal the decision or file a lawsuit to seek compensation. Below are some common causes of a denied disability claim in Arizona and San Diego. For further guidance, contact a San Diego long-term disability claim lawyer at Dawson & Rosenthal, P.C.
Insufficient Medical Documentation or Evidence
Written proof of a long-term disability must exist to support a claim. Evidence is supported through continual medical care from your physician, who will document the evidence of your injury. Evidence and documentation may include:
- Medical records and chart notes
- Prescription orders
- Diagnostic testing images, such as X-rays, MRIs, and CT scans
- Lab test results
Ensure your insurance provider has requested and reviewed all the essential documentation for a successful long-term disability claim. Evidence of mental disorders resulting in long-term disability must also be supported.
An Injury or illness is not Considered a Disability Under the Insurance Policy Guidelines
Reviewing and understanding your long-term disability policy and becoming familiar with its guidelines and terms, along with its definition of what constitutes a disability, is essential. Insurance policies can use complex, confusing language. For example, a policy may determine that a disability applies only if an individual cannot perform the duties of their occupation instead of defining a disability as being unable to perform any occupation.
The Policy Does not Cover the Injury or Illness
Certain medical conditions are not covered under long-term disability claims. For example, pre-existing conditions may be excluded from policy coverage. Additionally, a long-term disability claim may not cover the following conditions:
- A self-inflicted wound
- Alcohol abuse
- Drug abuse
- Injuries resulting from a crime
Illnesses with subjective levels of impairment may also be limited or denied coverage. Examples of these illnesses may include chronic fatigue syndrome or fibromyalgia. A long-term disability denial may lead to a bad-faith disability claim against your insurance company.
You Missed Deadlines
Not only is supporting evidence critical to a long-term disability claim but meeting the deadlines for filing and appealing a denial is also necessary. Missing a deadline will most likely result in your inability to file a legal civil action against your insurer. Your options for financial recovery will be limited or no longer exist.
Errors by the Insurance Provider
A representative reviewing your claim is expected to have the experience to make critical decisions concerning your claim. However, insurance representatives have various levels of knowledge and expertise. Document who you are working with and even request a second evaluation of your claim by another representative following a claim’s denial.
A Disability is Disputed
Insurance companies may opt to work with medical practitioners who have provided more favorable outcomes for them in the past. Asking for another medical evaluation or seeking your own independent evaluation may be beneficial in disputed claims.
An insurance representative may also uncover online evidence that your injuries are not as severe as you claim. Refrain from posting photos and videos on social media that serve as evidence against your claim.
Having your long-term disability claim denied may be corrected with a few simple steps. Sometimes, it takes legal action to secure the financial compensation you deserve. When you seek guidance for a long-term disability claim in Arizona or California, you can feel confident you have someone on your side advocating for your rights.