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What are the five most common reasons for long term disability insurance claims to be denied?

Friday, July 10th, 2015

1 – Insufficient objective evidence of disability.

This is perhaps the single biggest term we see when claims are denied. It’s a vast category that can be used for practically every single disability claim.

If you have an illness like Fibromyalgia, Lyme Disease, or Chronic Fatigue Syndrome, this denial is a softball for the claims adjuster. It is universally understood that there are no specific tests or images that appear on CAT scans, MRIs or X-rays for these illnesses. It doesn’t mean the claimants are not disabled. Providing proof of how and why someone is disabled is the key.

2 – Failure to be under the regular care of a treating physician.

If you are disabled, the expectation is that you are in need of medical care, have at least a primary treating physician and likely a number of specialists who you see on a regular basis.

We have battled and overcome denials where a client was not seeing doctors routinely because there was little that could be done for his/her particular condition. In most cases, however, claimants do need to be under a doctor’s regular care for a claim to succeed.

The treating physician also plays a key role in documenting your care and the specific reasons that you are disabled; i.e., the tasks and functions that you can no longer perform as a result of your disability.

3 – Psychological testing shows no evidence of impairment.

Disability insurance companies prefer psychological claims (also known as “mental/nervous” conditions) to physical because there are often specific policy limitations on how long they are required to pay claims. The typical time period for a mental/nervous claim is two years. Compare that to the cost of a twenty-year long period of benefits, and it’s easy to see why they attempt to push claimants into this category.”

4 – Own occupation policy or any occupation policy.

If you have an “any” occupation policy, the terms of your policy are straightforward and not in your favor. You can’t work at a data center because you can’t sit for extended periods of time? You can take a job at a fast food restaurant or in retail. Check your policy carefully – do you have an “any” occupation or “own” occupation?

5 – Surveillance video or evidence from a field visit by an investigator.

This denial letter comes once they have videotaped you going to a doctor’s office for a weekly treatment or taking out the trash when the trip from the front door to the trash cans is under ten feet. Surveillance is a frequent reason for denial or termination of a disability insurance claim, even when it is outlandish to claim that you are able to work because you take a monthly trip to see your doctor.

If your long-term disability insurance claim has been denied or terminated, call our office today to learn how we can help.

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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Frankel & Newfield does not currently handle any Social Security Disability Insurance claims.


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This is about a Social Security Disability claim.

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