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Common Reasons for Long-Term Disability Denials

Dec. 2, 2021

Man is filling in Disability insurance form.Having a healthy and productive workforce is crucial for the continued operation of any business. Long-term disability insurance policies are designed to protect a portion of an employee’s income should they become unable to work for an extended period due to a serious injury or illness. Unfortunately, insurance companies have become more and more aggressive about denying or terminating valid long-term disability claims in order to protect their profits.

If your long-term disability claims have been denied and you want to understand your options, consulting with an experienced Alabama long-term disability insurance attorney is crucial for detailed counsel. At R Willson Jenkins PC, we are dedicated to offering comprehensive legal guidance and reliable advocacy to individuals in long-term disability insurance matters. We will fight diligently to protect your appeal rights, guide you through the appeal process, and help you navigate key decisions. Our firm proudly serves clients across Florence, Tuscumbia, Sheffield, and Muscle Shoals, Alabama.

Common Reasons for Long-Term Disability Denials

Long-term disability claims may be denied due to a variety of reasons, including:

Video Surveillance: Insurance providers hire investigators to follow claimants, conduct private investigations, and take surveillance videos. If you are found to be performing any activity that is inconsistent with your indicated disability, your claim may be denied.

Late Filing: Your claims may be denied if you file your claims late or fail to submit the relevant information and necessary documentation within the specified deadline.

Lack of Objective Evidence: When filing your LTD claims, you may be required to provide objective medical evidence – laboratory reports, medical reports, and x-rays – that accurately describes the nature of your illness or injury and its impacts on your day-to-day activities. Failure to submit all necessary supporting medical evidence can result in claim denial.

Inadequate Medical Evidence: Your long-term disability claims may also be denied if you do not have sufficient medical evidence proving your medical conditions or disability.

Failure to Meet the Disability Threshold: Before you qualify for long-term disability benefits, you must meet a certain disability threshold or definition. Failure to meet this threshold can result in a claim denial.

Social Media Investigation: Insurance providers often search and monitor your online activity and social media accounts. If they find any evidence that contradicts the information you provided regarding your disability, your claims may be denied.

Others: Some other common reasons for long-term disability claims denial include:

  • Refusing to attend an independent medical assessment

  • Having a pre-existing condition exclusion clause in your LTD policy

  • Failure to communicate with the insurance provider

  • Disability conditions are not covered in your policy

  • Basic mistakes when processing your insurance claims

Under The Employee Retirement Income Security Act (ERISA) rules and regulations, the insurance provider must provide you with the reason as to why your claims were denied and information regarding the appeals process for accessing denied long-term disability benefits. An experienced attorney can evaluate your unique situation and guide you through the appeals process.

Your Right to Appeal

As mentioned earlier, if your long-term disability claims are denied, the insurance provider will send you a denial letter stating why your claim was denied. Under ERISA rules and regulations, policyholders will have up to 180 days from the date on the insurance company’s denial letter to file an appeal.

However, before filing an appeal, you need to read the letter carefully and understand why your claim was denied. A skilled lawyer can evaluate the reasons for your claim's denial and determine how best to proceed with your appeal.

How Legal Counsel Can Help

Filing for long-term disability claims usually involves a lot of complex procedures. Unfortunately, your long-term disability claims may be denied due to a number of different reasons. Nonetheless, you shouldn’t give up hope. An experienced attorney can fight diligently on your side to protect your appeal rights and help you appeal your denied claims in a timely manner.

At R Willson Jenkins PC, we have the experience and resources to guide and represent clients in long-term disability claims denial matters. As your legal counsel, we can study the denial letter, review the reasons for your benefits denial, and outline an effective strategy to file an appeal. Our team will track down missing records, request expert testimony, ask your physicians for written opinions, and advocate for you against the insurer. We will fight compassionately to protect your best interests and attempt to ensure that your long-term disability claim is approved.

If you received an initial long-term disability claims denial, don’t be discouraged. Contact R Willson Jenkins PC today to schedule a simple case assessment. We can offer you the comprehensive legal guidance and reliable representation you need and increase your chances for a successful appeal. We’re proud to serve clients across Florence, Tuscumbia, Sheffield, and Muscle Shoals, Alabama.

The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute an attorney-client relationship.