Top Reasons behind Long-term Disability (LTD) Claim Denials

by | Published on Jun 4, 2021 | Healthcare /Disability Insurance

Long-term disability (LTD) insurance is a part of a comprehensive employee benefits package that covers serious injuries and permanent disabilities that keep workers out of work for a long period of time like three months or longer. Having LTD coverage can support workers with a minimum wage and help pay the bills of a serious injury or illness. However, LTD does not provide coverage for work-related accidents or injuries covered by workers’ compensation insurance though an employee in the event of a personal injury such as a car accident or a fall will be covered. It is important for LTD claims to have clear evidence of disability. For disability lawsuits, attorneys can rely on medical review solutions to collect medical evidence to prove the claimant’s disability in court.

Claims administrators in insurance companies many deny disability applications for diverse reasons. Some of the most common reasons for denial are –

Not Filing On-Time

To get benefits for such insurance coverage, there will be a time frame starting from the date of disability within which the claim should be submitted to the insurance company. A claim that is filed late can be denied by the insurance on the basis of these clauses. Long delays in claim submission can make it difficult for insurers to manage the claim.

Not Submitting Supportive Medical Evidence

To prove long-term disabilities, it is necessary to submit proper medical evidence such as diagnostic imaging results, clinical notes, and blood test reports that prove that the claimant has taken regular medical treatments for their disability. Many insurers also recommend submitting the treating doctor’s statement to prove the claimant’s disability level and how the impairment limits their work abilities. At times, insufficient evidence to support disability could also lead to claim denials.

What Are The Medical Records Needed For Long-Term Disability Insurance Claims?

Not Meeting the LTD Policy’s Disability Definition

Based on the insurance plan, there will be slight differences in the definition of disability. In most long-term disability policy plans, the initial definition of disability is that a person will be unable to perform the duties of any job for the first 24 months. Insurers may terminate claims at the change of definition in their policy’s summary plan description. Insurers may also exclude certain conditions; for instance, medical impairments related to substance abuse or pre-existing conditions are often excluded from coverage.

Not Attending Independent Medical Exam

Many insurers will request the claimant to undergo an independent medical exam (IME) before approving the claim. The doctor chosen by the insurer conducts this examination and he/she may find reasons to disagree with the treating doctor’s diagnosis. Not attending the IME could result in denial of benefits.

Other common reasons for LTD claim denials are – treatment non-compliance or not submitting to reasonable medical treatment, not participating in rehabilitation or return to work as recommended by insurers, and credibility issues based on surveillance. With the support of accurate medical claims review, disability lawyers can efficiently handle lawsuits related to such claim denials and terminations.

Disclaimer: This content is for informative purposes only and does not constitute professional legal advice. For a professional opinion, consult a disability attorney.

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