Insurance Company Excuses to Deny Claims
There are many reasons why you can be denied long-term disability benefits. The insurance company is a for-profit company, meaning they operate to gain money. Paying money to claimants represents a loss to them. The company aims to minimize those losses by denying claims or shedding them as time goes on. They can offload cases by buying you out with a one-time payment (called a lump sum policy buyout) or selling the cases to other companies. They can also look for inconsistencies in your case or small details that will disqualify you from continuing to receive benefits over time. You have to be vigilant when the insurance company asks questions or requests documentation because it could be deadly to your case.
Why Do Insurance Companies Deny People?
Even tiny issues could have a big impact on your case. Here are some common reasons why a claim might be denied:
- Errors on a document. Maybe you inaccurately reported your income or an asset on your application. It could be forgetting to disclose something about your employment history. Anything they think is missing or inaccurate could be an easy way to deny you your benefits.
- Policy limits. Some insurance policies won’t cover certain conditions, and it’s important to know how your disability fits into your policy requirements. Conferring with a lawyer or doctor could be helpful for this. Also, some insurance companies will only cover a disability for a certain period. Once that time is up, they will cut you off from your benefits. This is usually for symptoms they deem “subjective” (e.g., pain, fatigue, trouble concentrating, etc.) or mental illness. It could also be that you lived through the maximum paying period of the claim. Some policies only cover up until retirement age.
- “Own Occupation” limits, individually and nationally. When you are evaluated for disability eligibility, the insurance company wants to know if your disability interferes with your ability to perform your work. This is to say that your disability has stopped you from being able to do substantial tasks that are required for your job. Many policies will cover your disability for a limited period (i.e., 1-2 years) when you are within this “own occupation” period. However, many insurance companies will evaluate the tasks required for your job by comparing them to how this job is performed across the nation. If you could do the same job at a different company to solve the issue (to avoid a work conflict or harsh demands from your job, for example), they will deny you.
- “Any occupation” period. Once you have exited the “own occupation” period where you have been deemed unable to adequately perform your job as done by people nationally, you will be evaluated to determine if you can do any job. If you could switch careers without being held back by your disability, the company would deny you and claim you could work instead.
What to Do If Denied
There are several steps to an appeals process that are available to you. Remember, you have the right to an appeal when you are denied. As soon as you are denied, check to see how long you have to file the appeal. Missing this window means that you may not be able to appeal at all, or you could have to start a new application again, which only delays any benefits you may receive. The insurance policy will likely require that you file an appeal through their company before you try to bring it to court. While you can file the appeal with the company by yourself, you have to follow their procedure closely to maximize your chances of success. Hiring an attorney at this time would make the process much easier on you, as you would not have to learn all of the rules and tricks that come with this process, and you would reduce your contact with the insurance company overall. A disability lawyer will be much more experienced, relieving stress.
Contact a Lawyer for Help When Your Claim is Denied
Being denied benefits is hard. It could mean you’re unable to pay rent or a mortgage, or you can’t support yourself and/or your family. With some due diligence, you can appeal the denial to the insurance company and, if necessary, bring it to the courts to decide. Contacting an attorney will maximize your chances of success because they will work with the knowledge that it could go to court someday. There are certain rules about what evidence can be introduced in court, and if it is not given at the right time, it could be barred from helping your case. Contact us today to get help from a disability lawyer.