Why Do Disability Claims Get Denied?
Group Disability Insurance benefits (benefits provided through a group policy through your workplace) usually contain a pre-existing exclusion clause for Long Term Disability Benefits. This clause does not usually apply to entitlement to short-term disability benefits, so you may have received those, but your long-term disability benefits may have been denied because of the Pre-Ex clause. In short, this clause allows your claim to be denied if you have only had coverage for a short period of time (usually less than one year) and have been suffering with the same medical condition in the past during a period that will mean that you cannot obtain your LTD benefits.This clause is included to protect the insurance company from having to provide benefits to individuals they would not otherwise have ever insured had medical disclosure occurred at the time you were hired. It may seem unfair, but it is mandated by the applicable insurance legislation.
In some cases, there may be a way around it, but this requires review and examination by an expert lawyer in disability insurance. Before you give up, it may make sense to have an experienced disability lawyer here at Share Lawyers review your situation to see if there is any chance of avoiding the Pre-Ex clause.
A response from the insurer that they are unable to make a final decision because information is missing from what has been submitted, is obviously very frustrating and hard to see as anything other than a delaying tactic.
If this is the reason for the denial or “non-decision”, the first thing to check is whether there is something that can be done to provide the missing or erroneous information. It is important to complete these forms as completely and accurately as possible to avoid this type of response.
In some cases, the request is for additional information not necessarily included in the initial forms, such as copies of health care providers clinical notes and records, medical test results, financial information, and the list goes on.
In many cases, it is hard to feel like there is no way to ever provide all of the information the insurance company says they need to make a decision. If you fall into that category, it may be time to consult with a disability insurance lawyer about whether the ongoing requests for information are reasonable, or they are just delaying the inevitable decision to deny your claim outright.
We see this reason frequently and it is probably the most frustrating one for claimants because, what they’re really saying is that they are not satisfied that whatever you are suffering with is serious enough to prevent you from going to work.It could be that your medical information is not emphatic enough about the reasons you cannot work, but in our experience, your doctors are probably as frustrated as you are in understanding what else they can provide that would substantiate the reasons for not being able to work. In many cases, if you go back to your doctor and ask them for more assistance, they may say, ‘what else is there for me to say’?
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This searchable database contains information about disability, critical illness and life insurance claims, and what you can do if you are denied or cut off of your benefits. It is a collection of the most common questions we receive from our clients. General answers have been provided by our lawyers.Here are some commonly asked questions to get you started: