Disability Insurance Blog

Did medical records play a part in your disability claim denial?

disability insurance

Monday, September 25th, 2017

You’ve carried long-term disability insurance to protect yourself and your family from poverty in the event of a catastrophic accident or serious medical issue, such as a stroke. After years of paying for coverage, you found yourself in need of your policy. Whether it was a car accident or a sudden medical event, adjusting to permanent disability can take time. Unfortunately, getting medical help and making your home accessible are expensive.

When you can’t work, it doesn’t take long to drain your savings just trying to pay your necessary living expenses. If your inability to work is permanent, you could worry about buying groceries, paying your bills and even retaining your home. Long-term disability insurance should protect you from the worst-case scenario, but what happens when your claim gets denied because of an issue with your medical records or documentation?

You have the right to appeal a denial

Many perfectly valid claims get denied because insurance companies don’t want to hurt their bottom line. The majority of insurance companies are for-profit businesses, and these businesses operate with the intention of making as much money as possible. Every claim that they have to pay out is a financial loss, particularly long-term disability claims which can require ongoing payments for years or even decades.

Completely legitimate claims can get denied for the smallest reasons. Thankfully, you have the right to fight back. Federal law governs the process, ensuring that you can appeal a rejection of your long-term disability claim. Long-term disability insurance offered by your employer is likely subject to ERISA guidelines. ERISA sets specific standards for employer insurance plans provided by private businesses. While you can’t have a jury trial, you will have an opportunity to present evidence and better documentation, if that is cited as the reason for the rejection.

Medical records can be confusing or inaccurate

The medical field, like many specialized careers, practically has its own language. There is so much jargon and so many acronyms that the average person would struggle to understand medical records or notes. The same could be true of a doctor in a different specialization or of a claims processor at an insurance company. A physician’s notes may fail to convey the seriousness of your condition, making it easier for the insurance company to reject your claim.

It’s also possible for doctors, who are human after all, to make mistakes in reports and medical records. Putting down the wrong acronym or diagnosis code could easily result in a claim denial. You can speak with your doctor to have documents updated and corrected. You may also need to consider obtaining a second opinion, depending on circumstances, to improve your chances of a positive outcome to your claims appeal.