Select Page

The 7 most common reasons Long Term Disability claims are denied.

Long term disability claims evaluated by insurance companies can be denied for any number of reasons, even in cases where a disability is clearly evident. An ERISA LTD attorney explains.


What are the main reasons a Long-Term disability insurance company would deny my claim?

According to the Department of Labor, from 2006 to 2010, long-term disability claims accounted for 64.5% of ERISA employee benefits litigation. Most long-term disability insurance plans provided by employers are governed by the Employee Retirement Income Security Act of 1974 (ERISA).

Denied LTD claims

Long term disability claims evaluated by insurance companies can be denied for any number of reasons, even in cases where a disability is clearly evident. An ERISA LTD attorney explains.

Long term disability claims evaluated by insurance companies can be denied for any number of reasons, even in cases where a disability is clearly evident.

It’s not unusual for an insurance company to delay or deny long-term disability claims based on suspect reasoning, but over time, patterns emerge. Understanding the most common reasons given for denials of long-term disability claims may help you in filing a successful claim.

  1.   Inadequate Medical Evidence.
  2. A claimant must prove he/she is receiving treatment from a medical provider on a regular basis. If you have a disability, you are expected to see a doctor or therapist on a regular basis. Similarly, if you have a psychiatric condition, you should be able to show that you are seeing a psychiatrist or psychologist. You must also provide proof of objective tests such as MRIs, x-rays, and lab tests when appropriate. If there are no exams, laboratory tests, evaluations or medications to support the claimed impairment, the insurance company is likely to deny your claim.

  3.   Missing medical records.
  4. Sometimes an insurer does not obtain all your medical records. In this situation, find out what records the insurance company requested and which records were received. Make sure the insurance company requested all of the documentation supporting your claim and those records were received.

    If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.

  5.   Missing doctor’s statement.
  6. Often, the most important piece of evidence in proving a disability claim is a written statement or opinion from a doctor detailing your disability and how it affects your ability to work. Many doctors find these statements or forms to be burdensome and annoying. If you are asking your doctor to set aside time to complete the forms for you, you should offer to pay for that time. Time is money to doctors, just like to everyone else. If your doctor is unwilling to provide a statement or complete insurance company forms, you may need to find another doctor.

  7.   Not meeting the insurance policy definition of disability.
  8. Each long-term disability insurance policy has a specific definition of “disability” which the policy holder is required to meet. These definitions vary considerably. Under an “own occupation” definition, a person is disabled if they are unable to carry out the duties of their particular job. Under an “any occupation” definition, disability is defined as the inability to perform the duties of any job. Some LTD plans transition from “own occupation” to “any occupation” after 24 months or a certain length of time. You should always get a copy of your policy and read your particular definition of “disability”.

    Long term disability lawyer

  9.   Some conditions are excluded from coverage.
  10. Long-term disability insurance policies often exclude certain conditions from coverage, such as drug or alcohol abuse. Other conditions such as depression or self-reported conditions may be limited to coverage of 24 months or less. Pre-existing conditions are also usually excluded from coverage. Once again, these provisions vary considerably. You should obtain—and read—your policy.

  11.   Video surveillance reveals inconsistencies in your claim.
  12. An insurance company may hire an investigator to follow you and record you participating in activities that appear to conflict with your claim and try to prove that you are not disabled. In most cases, a person has “good” days and “bad” days and a surveillance video may portray you on a “good” day.

  13.   Missed deadlines.
  14. Note all filing deadlines and the appeal deadline on your initial denial notice. You usually have 180 days to appeal an initial denial; if you miss the 180-day deadline, your options to sue an insurer in federal court are likely lost. Submit all medical records and documentation as soon as possible. Federal courts in ERISA cases are only allowed to consider evidence in the administrative record. The administrative record is anything an insurer or administrator looks at when deciding whether or not to pay a claim. This includes medical records, reports, bills, statements, and claim-related correspondence, as well as “peer review” reports, independent medical exams, and transferrable skills analyses provided by the insurer. Once a lawsuit is filed, the court’s review is confined to the administrative record and the court is rarely permitted to consider evidence outside the record.

ERISA was enacted to protect private pension and health plans from fraud and mismanagement, but because the Act’s regulations preempt similar state or local laws, they may deprive individuals of protections provided by “bad faith” laws.

ERISA and state “bad faith” laws are highly complex. If your long-term disability benefits have been denied, do not hesitate to seek legal advice. Bemis, Roach and Reed has successfully handled cases against: The U.S. Government, Aetna, Cigna, Unum, Hartford, Metlife, Prudential, Standard, Connecticut General Life, Life Insurance Co. of N.A. , Lincoln Financial, Northwestern Mutual, Reliance, Assurant, CNA, Fortis, Liberty Mutual, Paul Revere, and many others.

Share Post

best social security disability lawyer
Disability benefits are an important source of income for those who are unable to work. If you not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.

5 star disability lawyers

"Words can not truly express the gratitude that I feel toward Mr. Lonnie Roach and his professional team. I give them an A+++. Very compassionate and prompt. Their priorities are first and foremost helping you succeed at your case. When you feel helpless, feeling like someone is on your side can mean the world to you. Thank you for working for the people."
-Amy K.

Top SS disability lawyer
top disability attorney

Blog Feed

Neurocognitive Disorder and obtaining Social Security disability benefits

Neurocognitive Disorder and obtaining Social Security disability benefits

The SSA recognizes Neurocognitive Disorders in its Blue Book. To qualify for disability a person must meet the requirements of the listing or prove they are unable to work.

ltd assistance denied

best disability lawyer

board certified attorneys

Your Free Initial Consultation

At Bemis, Roach and Reed, if we can't help you, we will try to find the right attorneys for you.

We offer each of our prospective clients a free no obligation one hour phone or office consultation to see if we can help you and if you are comfortable with us. We know how difficult a time like this can be and how hard the decisions are. If we can be of assistance to you and help you find a solution to your issue we will even if that means referring you to another attorney.

Or simply call 512-454-4000
to schedule your
Free Consultation

Let's get you Started:

If you could provide us with some basic information about your claim we will get right back with you with a free case evaluation and schedule your Free Consultation Today.

Fields marked with an * are required

Call now for a FREE initial consultation
(512) 454-4000