When you are unable to work for a long time due to a disability, long-term disability benefits provide a crucial lifeline. But let’s face it: insurance companies don’t make it easy to get approved. They have strict rules, specific definitions of disability, and many reasons to deny claims. Even a small mistake on your application or a missing medical document could be enough to get your long-term disability benefits denied.
But we want you to know that having a long-term disability claim denied is not the final word.
There are steps you can take, and with the right guidance, you can challenge the decision.
Our team at Hunter | Everage assists people who have had their long-term disability denied.
Everyone deserves a fair chance to receive the support they need, and our experienced Richmond SSDI attorneys are here to help you navigate through the appeals process.
Contact us today at 704-377-9157 for your free consultation.
Incomplete or Insufficient Medical Documentation
Your medical records are the foundation of your disability claim. Insurance companies don’t just take your word for it when you say you can’t work—they want hard proof. If your medical records don’t clearly show how your condition limits your ability to do your job (or any job), they may use that as an excuse to deny your claim.
Sometimes, it’s not that you don’t have the right medical evidence—it’s that it’s not detailed enough. Maybe your doctor didn’t include specific information about your physical or mental limitations, or your test results weren’t explained in a way that connects them to your inability to work. Insurance companies look for any gap or inconsistency in your records to justify a denial.
To avoid this, talk openly with your healthcare providers about your disability claim. Explain exactly how your condition impacts your daily life and ability to work. Ask them to document specifics, such as your pain levels, limitations on movement, fatigue, or other symptoms.
Detailed records help paint a clear picture of your situation and can dramatically improve your chances of a successful claim or appeal.
Failure to Meet the Insurance Company’s Definition of Disability
Every insurance company has a unique definition of disability. Your insurer may argue that your condition does not align with their specific criteria. Some policies define it as being unable to do your current job, while others require you to prove you can’t do any job at all—which is a much higher bar to clear.
Insurance companies often use this vague language to their advantage. Even if your doctor confirms that you can’t work, the insurer might argue that you could do a “lighter” or “alternative” job. They may even bring in their medical reviewers—who have never even met you—to claim that you’re not as disabled as you say you are.
Pre-existing Conditions and How They Affect Claims
Most insurance policies have a “look-back” period, usually 3 to 12 months before your coverage begins. If you received treatment for a condition during that time, the insurance company may argue that your current disability is linked to the pre-existing one. Even if your condition got worse after your policy started, they might still use this as a reason to deny your claim.
However, this doesn’t mean your case is hopeless. If your long-term disability claim is denied due to a pre-existing condition, you may still have options. You can appeal the decision with additional medical evidence or legal support.
If you’re struggling with a pre-existing condition denial, speaking with an experienced disability lawyer can help. They can review your case, challenge the insurance company’s decision, and fight for the benefits you deserve.
Mistakes Made When Filling Out a Long-Term Disability Application
Mistakes on a long-term disability application can easily lead to your benefits being denied. Here are a few common errors:
- Incomplete Forms: Missing information can be a big red flag for insurers. Make sure every field is filled in.
- Missing Deadlines: Each step in the application process has a deadline. Missing any of these can jeopardize your claim.
- Incorrect Information: Simple errors like a wrong date or a misspelling of your medication can cause doubts about the accuracy of your entire application.
- Not Enough Detail: Vague descriptions of your disability or symptoms might not meet the insurer’s criteria for disability.
- Failing to Follow Up: After submitting your application, you might need to send additional paperwork or answer follow-up questions. Ignoring these requests can lead to a denial.
How to Appeal a Denied Long-Term Disability Claim
A denial isn’t the final word. Here’s what you can do in response:
1. Understand the Denial
Start by reviewing the denial letter from your insurance company. This letter should explain why your claim was denied and provide information on the appeal process, including deadlines.
2. Gather More Evidence
Collect any additional medical records, doctor’s statements, and test results that strengthen your case. New evidence that wasn’t included in your original claim can be powerful. Make sure all documents support your disability and how it impacts your ability to work.
3. Consult a Specialist if Necessary
If your disability involves complex medical issues, consider seeing a specialist who can provide expert insights into your condition. Their detailed evaluation can add significant weight to your appeal.
4. Get a Detailed Statement From Your Doctor
A supportive statement from your doctor is one of the most influential pieces of evidence you can include in your appeal. It should detail your medical condition, treatment, and prognosis, emphasizing why you are unable to work.
5. Write a Clear Appeal Letter
In your appeal letter, clearly state that you are appealing the denial and include all the new evidence. Address each reason for denial listed in the rejection letter, explaining why you believe the decision was incorrect.
6. Seek Professional Help
Working with an experienced disability attorney improves your chances of winning your appeal. They can guide you through every step and reduce stress.
Contact an Experienced Richmond SSDI Lawyer
It’s natural to feel frustrated or unsure of what to do next if your long-term disability benefits are denied. But a isn’t the final word.
Some steps can be taken to appeal the decision, and with the right guidance, you can significantly improve your chances of a favorable outcome.
Our long-term disability attorneys at Hunter | Everage have experience in handling these complex cases. We’re experienced at demystifying the often confusing terms and conditions of insurance policies, and we know how to challenge denials that should not have happened.
Contact us at 704-377-9157 for a free consultation. We are your trusted legal help when you’re hurting, and we are ready to help.