Long-term disability insurance is an excellent policy that provides financial benefits to employees who can’t work for extended periods due to accidents, injury, or illness. Ideally, you should pay for a long-term disability insurance policy if you suffer from a medical condition that qualifies for long-term disability insurance under the policy and file a claim to qualify for these benefits.
While you may satisfy all these requirements, most insurance companies focus on proving that you don’t qualify for insurance benefits under your policy terms. You should not only ensure that you learn more about your policy, but you should also avoid some common issues that can void your claim. Below are a few reasons your long-term disability claim can be rejected:
1. Your Claim Notification Wasn’t Timely
Your long-term disability claim can be denied because of untimeliness. Long-term insurance providers expect policyholders to file their claims immediately and follow up, despite their physical and mental health issues. Insurers can deny claim requests simply because they were filed outside the designated time frame. Adhering to time stipulations is important in every stage of claim processing. You should observe timelines for the following:
- Submitting claim notification
- Providing proof of long-term disability
- Responding to insurer inquiries
- Submitting documentation
- Medical tests, updates, and other medications
- Other requirements and deadlines for filing claims
While insurers should ideally deny claims for timeliness issues if your tardiness makes it impossible for them to handle your claims, missed deadlines open doors for the denial of valid claims.
2. Insufficient Documentation
Insurers can also reject long-term disability claims because of insufficient documentation. You should provide sufficient information to prove your long-term disability status. Important documents include:
- Medical history
- Medical records, tests, chart notes, and prescriptions
- Employment history
- Physician reports
Insurance providers have pre-developed claim forms that ease claim documentation. Even if the company doesn’t provide the forms, policyholders have the burden of providing proper documentation.
3. Your Condition Isn’t Covered By the Policy
Employer and individual long-term disability policies don’t cover all long-term disabilities. You should ensure that the condition responsible for your disability is included in your insurance policy. Most insurers exclude disabilities caused by self-inflicted injuries, war, and crime-related conditions.
Similarly, your disability claim can be rejected because your condition doesn’t meet the insurer’s policy guidelines. All policies have a “definitions section,” which defines and interprets various terms used in the coverage. Insurance providers often consider the policy terms and proof of disability before accepting or rejecting a claim.
4. Insurer Error
Some rejected insurance claims stem from insurer errors. The insurance claim process is long and tedious. As such, representatives from the insurance company can make errors during the claims processing process. Some representatives also don’t understand complicated medical issues, leading to wrong classifications and denial of the claim. Insurance claims should be handled within a given time frame, leaving a small time frame for insurer representatives to counter check their decisions.
Long-term disability benefits compensate policyholders a percentage of their income if they can’t work due to medical issues. However, you should understand these policies and provisions to enjoy their benefits. You should seek legal assistance if your claim is rejected for these or other reasons.