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5 Reasons Disability Insurance Claims Are Denied

By Brett Snider, Esq. | Last updated on

Disability insurance can be your safety net when serious medical problems hit, and it can be devastating to have those insurance claims denied.

If this has happened to you, don't lose hope just yet. After you figure out why your disability claim was denied, you may be able to make corrections and resubmit your claim, or you may have a good case for an appeal.

Here are five common reasons disability insurance claims are denied, and some thoughts on what you may be able to do next:

1. Missing or incomplete paperwork.

Disability insurance can mean the difference between continuously receiving up to 70 percent of your salary or drowning in medical bills. The first step, however, may make you feel like you're drowning in paperwork. Make sure you've collected all the necessary documents, which may include your insurance company's claim form along with medical records and treatment notes. Also, this is not the time to be sloppy with filling out your forms. Insurance companies will not cross your t's or dot your i's for you, and if your forms are missing vital or required information, that's an easy reason to deny your claim.

2. Claim filed too late.

Similar to statutes of limitations for crimes and civil lawsuits, your disability insurance policy may require a claim to be filed within a certain timeframe after your injury. Waiting too long to file a claim may mean you're out of luck.

3. Lying about your claim.

Not only is lying on a disability claim form not a good idea, it's a crime. By committing fraud in falsifying or fabricating information on a disability claim, you will at the very least jeopardize your chances of ever receiving one red cent from your insurance company. At worst, you'll be dealing with your disability issues behind bars.

4. Not following through with treatment.

If you've been prescribed physical therapy for your disabling injuries, then you need to make sure to follow through. Insurance companies are aware of the kind of treatments recommended for common disabilities, so you may be denied if you're found to be slacking. And definitely don't engage in any activities that your doctor wouldn't approve of like belly dancing.

5. The insurance company's doctor disagrees.

When making a disability insurance claim, it is par for the course to be examined by an insurance company's own doctor. Of course your personal doctor's opinion is worth something, but an insurance company will want a second opinion which may not work out in your favor.

What to Do Next?

What happens if you want to appeal the denial of your disability claim? It depends on your policy. If your disability insurance is through your employer, then federal law requires you to go through an administrative appeals process before you can file a lawsuit.

On the other hand, private disability insurance policies may or may not require a formal appeals process before you can sue. Because the rules can get complicated, it's best to consult an experienced disability lawyer who can examine your case and help guide you through the process. Keep in mind that many disability claims are initially denied, but are eventually successful.

Editor's Note, April 5, 2016: This post was first published in April 2014. It has since been updated.

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