After paying premiums for several years, you expect that when you have to file a claim for long-term disability your insurance company will take care of you. But as many policyholders have discovered, that’s not always the case. You’ve had doctor visits, testing, treatments, therapy, and filled out a ream of paperwork that they’ve asked for, only to see your claim denied. So what’s going on here?
Insurance companies are in business to make money and will deny your claims any way they can. These are some of the reasons your claim may have been denied.
They’re Watching You
Insurance companies regularly conduct video surveillance of individuals who file an LTD claim when they say they’re disabled and can’t work. Why? To prevent obvious insurance fraud, particularly by individuals who claim they can’t work because of an injury, but they’re publicly engaged in activities that they shouldn’t be.
Surveillance can be both long-range video and social media investigation. Even with your account set to “private,” it’s highly possible your vacation pictures and other “action shots” can be visible to people who you never intended. It’s always advisable to set your posts to “friends only,” but you should also be aware of who is following you and who you accept friend/follow requests from. Additionally, investigators may be able to access your account by demanding your passwords.
For instance, if you’ve filed a claim for a back injury that prevents you from working, and you post pictures of yourself surfing in Maui, that’s a clear indication that you’re not injured. Of course, if that picture is five years old, an investigator may not realize that, even if you date it.
Best bet: limit your social media postings, or deactivate or delete them until your case is decided.
Not Enough Medical Evidence
Any kind of insurance claim needs sufficient medical evidence to support it. Evidence is key to supporting your claim and showing that you are, indeed, disabled.
- Consistent medical treatment for your condition(s). Your insurer expects that you are receiving consistent and regular medical care for the condition you are claiming. If you aren’t receiving regular medical care, the insurer will interpret this as your condition isn’t serious. Physical illnesses will include physician visits, as well as any required testing such as X-Rays and MRIs. If your claim includes mental illness such as depression, you should be seeing a mental health provider (such as a psychologist or psychiatrist) on a monthly basis or better.
- A doctor’s statement detailing your medical condition and how your disability limits your ability to work. Don’t rely on the insurance company’s forms—they are designed for you to respond in a way that will ensure your claim is denied. Should your doctor deny you support for your disability, find another one who will help.
- Absent medical records that are essential to proving your claim. If the insurance company hasn’t requested all relevant records, request a list of all the records they have already requested an a list of what they’ve received. Then insist that the insurer request all the records on the list. You may have to be persistent until they have all of your medical records.
Missed Deadlines
Insurance companies are notorious for deadlines, and even one day can end your claim. Make sure you understand their deadlines for both applications and appeals.
You Don’t Meet Their Definition Of “Disabled”
As ridiculous as this may sound, most policies have strict definitions of what “disabled” actually means.
One of the biggest sticking points is “own occupation” and “any occupation” clauses in the policy.
“Own occupation” indicates that your disability prevents you from fulfilling the requirements of your current occupation. “Any occupation” means that you are unable to fulfill the requirements of any occupations. Some policies begin as “own occupation” but transition to “any occupation” after 24 months.
Additionally, pre-existing conditions and medical conditions related to current or prior substance abuse tend to be excluded. Mental conditions and those that are based primarily on self-reported symptoms, such as fibromyalgia and chronic fatigue syndrome, may be limited to 24 months of benefits after approval.
Your Houston LTD Disability Attorney
When applying for long-term disability it’s important to follow your insurer’s instructions to the letter. They’re not interested in helping you and your claim, but there’s someone who can help. The Herren Law Firm can help you with your application, appeals and help you through the process so you can get the benefits you need. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, because we will only collect if we win your case.
