Having any insurance claim denied can be frustrating, but with disability claims, it can be financially devastating. By understanding the most common reasons for denial, you can do your best to guard against them.
Lack of objective evidence
When approving or denying a claim, claims adjustors look for hard evidence that supports your filing. In essence, this means documentation from a third party that affirms your statements made to the company. Examples of objective evidence include x-rays, lab results and doctor’s statements. If, for some reason, there is no objective evidence in your case, you may need to work with a lawyer who specializes in disability insurance claims.
Disability is unrelated to your job
Some claims adjustors will look at your job and determine that, based on a generic description, your disability does not prevent you from performing the tasks necessary to your profession. If your disability insurance is specifically tied to on-the-job injuries, you can also be denied if the disability was incurred in an unrelated situation.
Presence of preexisting conditions
If your disability is related to a pre-existing condition and you are in the period of exclusion, your claim can be denied. Additionally, if the disability is a result of not seeking treatment for a pre-existing condition, the company can choose to deny the claim, stating you should have reasonably sought treatment before things got worse.
Disability within the elimination period
Disability policies usually have an elimination period. This lasts as little as 30 days and as long as six months after the disability incident. If the disability is resolved before the elimination period is over, the company will not pay out benefits.
Not seeking medical treatment
An insurance company will want verification that you have sought out all appropriate methods of treatment that could possibly rehabilitate you to the point of being able to work again. If you have not, it will be assumed that your disability is not as you are claiming and coverage can be denied.
If you do not currently have disability coverage but are interested in taking out a policy, speak with an insurance broker.
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