Long-Term Disability Claims Denial in Carrollton
Applying for long-term disability (LTD) insurance benefits is relatively simple. However, receiving those benefits can be an uphill battle. While most long-term disability insurance policies are “contracts” between insurance companies and policyholders with very specific terms and conditions, many insurers routinely deny policyholder benefits. Long-term disability claims denial in Carrollton sometimes occur for a lack of information and other times for seemingly no reason whatsoever. It may be critical to prepare a strong case with the help of a distinguished long-term disability attorney.
Common Reasons for LTD Denials
Some of the most common reasons for long-term disability insurance benefit denials include failing to provide sufficient medical evidence of a disability. It can often be a difficult task if the policy does not provide guidance on what the insurance company considers to be “sufficient” evidence.
Being caught on camera is another common reason for long-term disability claims denial in Carrollton. Most people do not realize the length that some insurance companies go to in order to deny claims. In fact, many long-term disability insurers will follow applicants and try to catch them engaging in activities which show they are not disabled. A common example is someone claiming disability for a bad back and having an insurance company take a video of someone who is clearly not disabled.
While that would almost certainly make a claim implausible, most videos show someone simply engaging in everyday life activities to the best of their abilities – despite their disability. Insurance companies do not often see it that way and applicants must turn to counsel to fight on their behalf. Insurance companies often deny long-term disability insurance claims when applicants may no longer be able to work in their profession for their current employer, but may be able to work in their profession for another employer.
Establishment of Effected Work
If a grocery store checkout clerk becomes disabled and can no longer stand for long periods of time, they may be able to work as a grocery store checkout clerk for another employer who allows clerks to sit while cashiering. That is a very simplistic example, but a common theme among insurers. The bottom line is that a medical professional must determine how a person’s disability will affect their ability to work – not an insurance company.
How Can Insurance Companies Argue the Disability Claim?
Possible reasons for injured party’s role in long-term disability claims denial in Carrollton include:
- Failing to meet the definition of disability under the insurance policy. Although most long-term disability insurance provides a definition of what constitutes a “disability,” many provide definitions that are intentionally vague – for just that reason. Applicants often have to fight with their insurance companies over this definition, and many end up contacting a long-term disability insurance lawyer or filing an administrative appeal to resolve the issue.
- Having an impairment related to “something else.” Insurance companies often argue that a disability is not really a disability because it relates to a preexisting condition, substance abuse, or some other type of subjective symptom. In essence, the insurer is saying that the disability is really “something else” – and not covered. A medical professional must determine a person’s disability came about – not an insurance company.
- Missing a deadline. Although seemingly insignificant to receiving benefits, insurance companies routinely use this to deny claims. Anyone who has missed a deadline should not simply walk away. Exceptions to rules can always be made.
- Providing medical evidence that is not within the time frame of the disputed period. Applicants who provide medical evidence that does not pertain to the dates in question will almost certainly be denied their long-term disability benefits.
However, many well-intentioned applicants provide insurance company claims adjusters with “more” information than was requested – simply because they have it and feel that it may be helpful. Many insurance companies use that as a reason to deny coverage.
Speaking with an Attorney
Anyone who has been denied valid long-term disability insurance benefits should keep in mind that there are always options available to them, including contacting a long-term disability insurance lawyer to fight for them. They can also report insurance companies to Georgia’s insurance commissioner, or file a bad faith insurance lawsuit against the insurer is the policy is not employer-based. It may be critical to speak with an attorney about long-term disability claims denial in Carrollton and how to try preventing them.
