5 Reasons Why Disability Insurance Claims Might Be Denied was written for Playlouder by a contributing author. Please note that contributing opinions are that of the author. They are not always in strict alignment with my own opinions. –Joe.
Disability insurance helps you secure a source of income for when you’re unable to work because of a disability. It provides you with a partial income, making it easier to pay your bills or cover the necessary treatment costs.
Disability insurance can be obtained through government programs such as Social Security Disability Insurance (SSDI) or private insurers. Unfortunately, getting disability insurance is not always as straightforward as we would like.
Many disability insurance claims are often denied by both public and private organizations. However, the logic behind these denials is not always clear. To help you understand your situation better, below, you’ll find some of the most common reasons why your DI claim failed.
Your Existing Insurance Policy Has an Exclusion
These days, many realize the importance of being prepared for the worst and decide to insure various crucial aspects of their lives.
However, this also creates a problem. Every insurance has large amounts of fine print used to define the policy's rules. The more insurance policies you have, the more likely you are to miss exclusions the provider can use to deny your claim.
It might be possible that one or more of your policies has an exclusion targeting those with a disability. For example, the early symptoms of your condition can be described in the fine print and serve as a ground for denying your disability insurance claim.
If that’s the case, consider contacting an insurance agency or insurance denial lawyer in order to review your medical records closely. These records will be then used to review the analysis performed by your insurance provider and check if the claim denial was legally and medically compliant. If it’s not, and the case ends up in court, there is always an option of settlement loans if you cannot wait too long for the money.
Your Disability Insurance Claim Was Filed Too Late
Not all disability insurance claims are denied due to complicated medical or legal reasons. Sometimes it might turn out that you simply took too long to file your DI claim.
Before submitting your disability insurance claim, always remember to check the Proof of Claim or Notice clauses. Usually, one of these two provisions includes a time frame during which you can file your claim. Exceeding that timeline can be treated as a ground for claim denial by the insurance providers.
However, not all is lost. Even if you don’t submit your disability insurance claim within the stated time limit, there might be legal precedents for overturning the denial. The outcome usually depends on the reasons for the delay and the amount of time since the deadline.
You Refused an Independent Medical Assessment
As a person living with a disability, you surely know everything about your condition and how it affects your life. Unfortunately, the insurance companies don’t have that knowledge, and they can’t just take you for your word. Because of that, they have the right to send you to a chosen medical specialist for an evaluation.
This process is called the independent medical assessment and provides an opinion to the insurers about your state. For example, companies need to understand the severity of your symptoms and whether there are any recommendations for treatment. They also need to know if your condition is truly disabling from a medical or legal standpoint.
You have the full right to refuse the IME evaluation. Some medical practitioners might be more favored by the insurance companies due to their opinions. However, it’s better to simply attend the assessment and protest a wrong opinion than refuse the check-up outright. The reason here is that lack of IME testing usually results in the immediate denial of your disability insurance claim.
Your Disability Status Was Contested
To accept a disability insurance claim, any insurance provider needs proof in the form of medical evidence. Sometimes, however, even the medical opinion might be inconclusive.
There are two scenarios here that might have happened:
The Evidence for Your Disability Was Insufficient
Even if you attend your Independent Medical Assessment and get a favorable result, the insurance companies might still doubt your condition. This usually leads to an additional consultation with a different specialist and a second, negative opinion. Your symptoms might be found not severe enough to allow for disability insurance, or the frequency of any incidents might not be high enough.
There Was No True Evidence
It’s certainly possible that you have a disabling condition that won’t provide a piece of objective evidence. What this means is that it wasn’t possible to truly verify your state using various tests such as MRI scans or X-rays.
Unfortunately, there are many debilitating conditions that fall into this category. For example, it might be impossible to medically confirm issues such as chronic pain – even if you suffer so much that you can’t move. Private providers might use this to imply that your symptoms are only self-reported and therefore don’t serve as a ground for disability insurance.
Because of that, try to look for insurance providers that don’t require objective medical evidence.
You Were Assessed Incorrectly By The Insurance Provider
Some disability insurance claims get denied if you’re wrongly assessed by the insurer. Your provider might believe that your current job is compatible with your disability, especially if your employer does so, too.
To give you an example, chronic pain in your feet is not necessarily enough to prevent you from working remotely – after all, you don’t have to commute to work or move excessively during your working hours.
However, this doesn’t take into account the intensity of your pain. It’s possible that even sitting in a chair leads to significant discomfort and makes it impossible to focus sufficiently.
In some cases, insurers decide to hire investigators to research your activities and online presence. Using this data, the insurance providers might wrongly perceive you as able to work despite your disability. They might find out that despite partial blindness, you’re able to consistently post long-form content on your social media accounts.
In their eyes, it might imply that you’re able to perform desk jobs. However, it doesn’t take into account the existence of speech-to-text programs or that a family member types these messages for you.
As you can see, there are numerous reasons why your disability insurance claim was denied. It's possible that one of your existing insurance policies has a written exclusion regarding your symptoms or the disability at large. You might have refused an independent medical assessment or simply submitted your claim after the specified time period.
Your medical evaluation might also provide insufficient evidence for your disability or even no evidence at all. Finally, the insurer might misunderstand your condition or activities and wrongly deny your disability insurance claim.
Once you understand the reason behind the denial, it might be good to contact an attorney and discuss the options available to you. In many cases, there might be strong arguments to overturn the verdict.
Alternatively, you can also try to find a different insurance provider that doesn't require as much evidence as the first one. No matter what you choose, don't resign yourself – the fight for your disability insurance is more than worth it! Good luck!