Long-term disability benefits are meant to provide people who become disabled with a financial safety net during the time period in which they are unable to work. Although these benefits are necessary for many people who unexpectedly become disabled, a number of first time long-term disability claims are denied.

How Many Long-Term Disability Claims Get Denied?

Unfortunately, many initial long-term disability claims are denied. Under a federal law called Employee Retirement Income Security Act (ERISA), disability applications are generally evaluated by claims administrators who work for your insurance company, rather than by independent reviewers. Due to this conflict of interest, many claims that appear to meet disability qualifications are initially denied.

Many consumers who have submitted for long term disability insurance benefits may wonder, why do long-term disability claims get denied?

Why Do Long-Term Disability Claims Get Denied?

There are many reasons why long-term disability (LTD) claims may be denied – but applicants can always appeal an LTD denial.

One common reason for denial is insufficient medical evidence. When applying for LTD insurance, it is important to include documentation supporting your disability claims. This medical evidence may include medical records, objective tests such as x-rays, MRIs, or CT scans, and physician statements explaining how your disability affects your life.

It is also important to show that you require regular medical treatment. Providing documentation to prove that you make regular visits to your physician may aid you in having your application approved.

Applicants who have failed to meet their policy’s definition of disability may also be denied. Some insurance policies only define disability as being medically unable to carry out the duties of your specific occupation. Other policies exclude disabilities related to pre-existing conditions or substance abuse.

Many policies have different criteria for conditions that can be proven by objective testing and conditions that are diagnosed based on subjective complaints. While many physical conditions can be proven by testing, mental conditions may be much harder to prove. For example, although mental health conditions such as anxiety and depression may interfere with someone’s ability to do their job, the effect of invisible disabilities may be harder for insurance claims reviewers to conceptualize, leading to a high percentage of these claims being denied.

Some long-term disability claims can still be denied, even when applicants have submitted all the necessary documentation and medical information. In addition to reviewing medical records, some insurance companies may investigate applicants to determine whether they are really disabled. Many insurance companies hire investigators to follow applicants and take video surveillance of them to compare against the disability claims made in their applications.

If your doctor has put you on physical restrictions, it is important to comply with them. Even people who have disabilities that result in good or bad days may be at risk of their claims being denied if they are recorded doing something that the insurance company believes proves that they are not disabled.

And in some cases, denial is alleged to be bad faith insurance, where insurance companies put profit over customer well being.

Applying for long-term disability insurance and going through the appeals process if you are initially denied may be a lengthy and confusing process. Hiring an experienced attorney to assist you in your application and appeals may make it more likely for you to win your case and receive benefits.

Get Help With Your Long Term Disability Insurance Appeal

If an insurance company denied your long-term disability insurance claim within the past 180 days, a knowledgeable insurance attorney can help you appeal.

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