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Top Reasons Insurers Give For Denying Disability Benefits

A severe injury or psychological trauma can undermine a person’s ability to work. Sometimes the consequences of such unfortunate incidents last a long time, and the person can no longer maintain employment.

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Long term disability insurance is meant to provide people in this situation with an income. The premiums people or employers pay for this insurance allow them to have some peace of mind when confronted with difficult and disabling circumstances.

But insurance companies sometimes delay processing of claims or deliver an outright denial of benefits. Disputes typically arise over the severity of the disability.

An insurance company might interpret a person’s chronic pain as manageable instead of disabling.
Psychological trauma that leaves a person emotionally unstable is difficult to measure. An insurance company might claim that there is not enough evidence to support the patient’s long term disability.
An insurance company might declare that certain types of injuries are not associated with long term disabilities.

How to Avoid Getting Long Term Disability Denied

A person preparing an insurance claim should be careful to document conditions thoroughly on an application. Medical records associated with the claim should contain clear statements about the level of pain or physical or mental incapacity suffered by the patient.

When a physician uses ambiguous terms on a medical record, it gives an insurance company a way to make a different interpretation. Medical records that contain concrete terms and definitive diagnoses help prevent denials.

Before sending in a claim, a person should make sure that the paperwork includes clear statements from physicians along with results from physical and lab tests. Building a clear picture of long term disability is essential.

Sometimes additional medical exams are needed to strengthen an application. Exams focused on defining a person’s level of pain will make the claim more defensible. Initial records from the time of the accident or disease diagnosis may not be enough.

Because a lot is at stake for people who need long term disability, they sometimes seek legal representation. An attorney experienced with insurance companies may be able to review a claim application and spot language that could trigger a denial. In Toronto, Howie, Sacks & Henry is a law firm that regularly supports clients with insurance claims.