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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.

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Sorry, we do not handle SSDI/Social Security claims.

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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