If you have been injured and suffered a serious medical condition that might leave you with a disability and prevent you from working, you may apply for long-term disability benefits. However, there is no 100% guarantee that your insurance company will accept the application. The company may try several things to hold the money as they look for loopholes. Additionally, you might make some mistakes that might lead to the denial of your claim. Therefore, it will be helpful to understand why claims get denied. An Ohio long-term disability lawyer can help you understand these mistakes and ensure you don’t close on the chance to get your claim approved by the company. Here are the top 6 reasons insurance companies reject some applications for long-term disability benefits.
The Condition Does Not Meet the Definition of Disability in the Policy
Your insurance policy has a definition of what qualifies as a disability. In most cases, disability is based on the ability of a person to perform duties under their occupation. Some terms and conditions govern what is considered a disability which every policyholder must meet. Therefore, review your policy to know if your condition meets the definition before applying for the benefits.
There is Inadequate Medical Evidence
Another major reason why your application for LTD benefits may be denied is because of a lack of adequate medical evidence to prove your disability. Your claim must be supported by a written document that proves your disability. You must show that your medical condition or injury has prevented you from going to work. The evidence must be proved by a certified medical professional, not an independent one. You will also need to show you have been getting regular MedicareAdvantageplans2024.
The Policy Does Not Cover the Condition
You may not get the benefits if the policy does not cover the condition. For instance, ERISA and private plans don’t cover conditions like alcohol and substance abuse disorders or crime-related injuries. So, understand what is covered in your policy.
You Missed Deadlines
Filing a long-term disability claim has a time limit after which your eligibility expires. Therefore, make sure you submit all the requested documents before the deadline set. You can also apply for an appeal after your claim is denied within 180 days. However, providing all the documents on time is crucial to prevent the denial of your application.
The Doctor’s Statement is Missing
You need the doctor’s statement to prove your disability. The statement should record your condition, explain your limitations, and how these limitations hinder you from working. Ensure your doctor writes and submits the statement to the company for approval.
There are Inconsistencies in the Evidence
If the insurer notices inconsistencies in your claim. There is a chance they will deny the claim. The company may send someone to watch you at home or talk to your neighbors to prove you are not disabled. Any discrepancy may damage your claim.
If your long-term disability benefits have been denied, it is crucial to speak to a lawyer. They will help you get justice. However, avoid these things that may result in denying your claim in the first place.