• Brandon S. Peters, Esquire

Long Term Disability Claim Denials


We wrap up our series this month by exploring some of the reasons why long-term disability claims are denied. Long-Term Disability Insurance was created to provide a replacement income to the claimant in the event of a "qualifying event." Qualifying events may include chronic pain, cancer treatments, or debilitating illness or injury lasting more than 26 weeks. In most cases, if an employee can qualify for another form of income replacement, such as Social Security Disability Insurance, the Long-Term Disability policy will no longer provide benefits.


Long-Term Disability claims are usually denied for one of these reasons:


Application errors: If the claim application has errors in it, is incomplete, or isn’t filed in time, it may be denied. Claims administrators may look for any mistakes in the application and use those errors as their rationale for denying your claim.


Missing or insufficient medical evidence: Long-Term Disability claims often get denied if they lack sufficient information to justify an approval, such as omitting to include copies of your medical records and a medical statement from your treating physician.


Not meeting an insurance policy’s definition of "disability": Under many insurance policies, a claimant is only considered “disabled” if they meet the specific criteria outlined in their insurance plan. A policy’s summary often includes a list of excluded conditions.


If you’ve received a letter denying a Long-Term Disability claim, contact us today. Most of these policies are ERISA policies, and therefore the claim appeal process has specific and limited remedies which make it important to hire an attorney who is qualified to handle your case.


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