Six Behind The Scenes Reasons For a Long-Term Disability Claim Denial
When filing a long-term disability claim, there are numerous important procedures you must follow and firm timelines that must be adhered to. Even if you feel you have fulfilled all requirements, your benefits may be denied or delayed. In some cases, there are problems behind the scenes you may not be aware of. The following are six common issues claimants encounter.
- Problems With The Terms of Your Policy
Unfamiliarity with the terms of insurance coverage provided by an employer is common. It can come as a shock to find benefits were not in effect during a certain time period, changes in your job classification impacted your eligibility, or there are some other requirements you failed to meet which affect coverage.
For this reason, one of the first steps you need to take when considering filing a long-term disability claim is to request a copy of all policy-related documents. The Employee Retirement Income Security Act of 1974 (ERISA) requires your employer to provide these documents free of charge and at your request.
- Your Condition Is Not Covered
Even if you are eligible for long-term disability benefits, your specific condition may not be covered. Insurers often include policy exclusions, such as pre-existing conditions or those you failed to specifically disclose to the insurer when the policy went into effect.
- The Plan Administrator Failed In Their Duties
Much of your claim, and your policy benefits for that matter, rests upon the competence of your plan administrator. Failure to submit or process claims forms and to communicate as needed with the insurance company is a common problem, as is allowing policies to lapse due to unpaid premiums.
- Your Doctor Failed To Provide Adequate Medical Records
Doctors’ offices are busy places and it is easy for important information to get lost or overlooked. Even if you were diligent in obtaining the appropriate medical care, documenting doctor visits, and adhering to their instructions, a simple clerical error on their part could lead to a denial or delay of your disability benefits.
- Insurance Company Doctors Disagree With Your Provider
Insurance companies are for-profit businesses. One of the ways they make money is by finding ways to avoid paying out on claims. It is not uncommon for doctors they hire to disagree with your own provider’s findings.
- You Were Observed Engaging In Activities That Undermine Your Claims
Insurers may hire investigators as part of the claims process. Their goal is to uncover information about your activities which can be used to undermine your claim. One of the first places they look is social media accounts, such as Facebook. Information you post or pictures you are ‘tagged’ in serve as evidence against you.
Let Us Help You Today
At Farrell Disability Law, we can help to determine why your claim was denied and provide the professional legal guidance you need in filing an appeal. Contact our Jacksonville long-term disability attorney and request a consultation in our office today.