Five Reasons LTD Claims Are Denied


Long-term disability (LTD) insurance coverage is available through your employer’s disability plan. Also, it can be bought directly from a provider. No matter which type of coverage you have, insurance providers may give you a fight. But a skilled disability attorney can help you take steps to avoid a claim denial. They will educate you about conditions that qualify for LTD and the necessary evidence to collect.

When an insurance provider handles your claim, they examine your policy and analyze the agreements to confirm that you are covered. Then, the insurer will review the limitations of your policy, waiting periods, scheduled benefits, limitations, exclusions, and conditions. Usually, such provisions limit the benefits you can get every month. Sometimes, they eradicate your right to bring a claim. Below are common reasons your LTD claim may be denied:

Failure to Offer Timely Documentation and Notification

 If you file an LTD insurance claim, you must observe timeliness. No matter your condition, you must give immediate notice and prompt follow-up. Your claim can be denied if you do not comply with requests from the claim handler within a certain timeframe. Timeliness is important at each claim-handling stage such as notification, disability proof, submission of documentation, response to inquiries, medical updates, and other requirements. 

Failure to Offer Sufficient Documentation

Insurance companies make claim decisions according to written disability proof. They will require you to provide them with sufficient data to determine your LTD status. Information such as medical records, employment history, doctor’s narrative reports, and your medical history must be submitted to the insurer. 

Coverage Exclusion

 LTD disability plans only cover some disabilities. Some plans may offer coverage for conditions that are part of a schedule of benefits. Usually, exclusions get rid of coverage situations the insurance provider does not cover like self-inflicted injury, war, and crime-related disabilities. 

Pre-Existing Conditions

LTD policies may not pay benefits if your disability resulted from or is associated with a pre-existing condition. But coverage limitations for pre-existing conditions are not absolute. The provision may not apply if you actively and continuously work for a certain period before your disability happens. But this exception depends on your plan. 

Not Meeting Disability Guidelines

Insurance companies define policy terms differently. These terms are defined in the Definitions section of your policy. A disability lawyer can give you guidance in this matter. 

If the insurer denies your claim for failing to meet the disability guidelines they set, this does not mean the insurance company is not convinced that you are disabled. Sometimes, this could mean you or your treating doctor failed to offer sufficient documentation to prove your condition or disability.