Can Your Insurance Company Deny Disability Claims?

Disability insurance is something you hope you’ll never need, but it can be crucial if you become sick or injured and aren’t able to work. Disability insurance provides a portion of your income for a set amount of time to help you continue managing your finances (and your life) while you recover. 

However, sometimes insurance companies deny disability claims. When you’re dealing with an illness or injury, the last thing you need to worry about is an insurance denial, but it’s an unfortunate reality. Let’s talk about what steps you can take if your claim is denied.

What is disability insurance?

Disability insurance provides a portion of your income if you cannot work due to illness or injury. Some employers offer short and long-term disability policies, or you can purchase your own policy separately. Many individuals also have disability insurance through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs.

In general, short-term disability covers a larger portion of your income (sometimes up to 70%), but it typically only offers coverage for up to six months. Short-term disability covers your income while you are out of work because of an illness or injury. Short-term disability can also be used for maternity leave coverage, depending on the employer’s policy and state requirements.

Long-term disability offers a lower percentage of your salary (usually 40%-70%), but it provides coverage for a longer period of time. Depending on your unique circumstances and policy, it could offer coverage for several months or years. 

What constitutes a disability claim?

While your specific policy will outline what is considered a disability, but it generally means that:

• You have an impairment (psychiatric, medical, or psychological) that prevents you from being able to perform a substantial amount of work 
  • You will need to provide documentation of the impairment – including confirmation from your physician, exam notes, and more
• Your impairment prevents you from earning gainful income
  • For Supplemental Security Income in 2022, that amount is $1,350 per month (but this can vary depending on your circumstances)

Common short-term disability claims include:

• Cancer
• Pregnancy
• Mental health 
• Injuries and musculoskeletal diseases

Common long-term disability claims include:

• Connective tissue/musculoskeletal disorders
• Cancer and/or tumors
• Mental health
• Cardiovascular or circulatory disorders
• Nervous system disorders

What if my disability claim is denied?

The disappointing truth is that even if you pay your premiums on time every month, your insurance company can still deny your claim. Some companies are determined to find reasons to prevent you from receiving the coverage you deserve under your policy, and managing an insurance denial on top of a medical difficulty and loss of income is something no one should have to deal with. 

What you may not know is that some unethical insurance companies resort to unbelievable tactics to back up their claim denial. They might try to say your claim was fraudulent or hire investigators to monitor your activities. This can be distressing and frustrating – especially while you’re managing your own challenges and reduced income. 

Common reasons that insurance companies give for denying claims include: 

• Inadequate medical documentation
• The impairment doesn’t meet the specific definition of “disability” per the policy
• Missing statements or notes from the doctor
• The insurance company’s medical examiner disputes the doctor’s findings
• Evidence from surveillance (like talking to friends/neighbors, social media monitoring, etc.) that the insurance company believes is proof the disability isn’t as severe as initially claimed

If you find yourself in this situation, you need to take action. First, you can attempt to contest the denial to show your insurance company why their denial was in error. This is typically done by requesting an appeal (insurance companies usually have online forms to start the process). If that fails to produce a positive result, your next step is likely litigation. That’s why you need a dedicated team with experience in challenging disability insurance denials. 

Our team has extensive experience advocating on behalf of clients whose claims have been wrongly denied by their insurance companies. If you believe that an insurance company denied a viable claim for you or a loved one, reach out to our team today.

The information contained herein is for general purposes only and does not constitute legal advice