Denial or termination of your Long-Term Disability benefits (LTD benefits) is usually an incredibly challenging experience. We have seen various reasons why individuals may find their LTD benefits denied or terminated at different stages. It could happen at the initial application stage, at the change of definition, or at any point thereafter. We can help our clients successfully appeal these decisions to have their LTD benefits reinstated or get a lump sum settlement.
Some of the most common reasons why Long-Term Disability benefits may be denied or terminated are as follows:
Social Media Platforms Surveillance
In today’s digital age, social media has become a significant source of information for disability insurance companies. Insurers may conduct detailed investigations of claimants’ social media profiles to gather insights into their daily activities. Discrepancies between the claimant’s online activities and limitations documented in medical records can challenge the validity of the disability claim. It’s essential for claimants to exercise caution regarding their social media presence and privacy settings, especially if they’re pursuing legal action against their insurer for Long-Term Disability benefits.
Failure to Follow Treatment Recommendations
Many LTD insurance policies require that claimants must actively engage in appropriate medical treatment to be eligible for benefits. For example, policies from providers like Sun Life or Manulife often require following treatment plans or medical advice. Failing to comply with treatments or therapies that could potentially improve or manage your condition, may provide grounds for the insurer to deny or terminate Long-Term Disability benefits.
Pre-existing Medical Conditions
LTD policies frequently include clauses excluding coverage for pre-existing medical conditions. If a claimant’s disability is deemed related to a condition that was diagnosed or treated before the policy’s effective date, the claim may be denied. Insurers review the claimant’s medical history during a specified period of time, preceding the policy’s commencement. This poses a significant challenge for individuals with pre-existing conditions. In such situations your lawyer may be able to help address this issue.
Contradictory Assessments
Conflicting assessments by the claimant’s treating physician and the insurer’s representatives, such as claims adjusters or in-house doctors, can lead to denial or termination of Long-Term Disability benefits. Insurer-appointed medical professionals may assert that the claimant is capable of working, overriding the recommendations of the claimant’s physician. This discrepancy often arises due to potential biases or financial interests influencing the insurer’s assessment process.
Inaccurate or Incomplete Information
Application errors or omissions in the initial disability benefits application can also result in denial or termination of benefits. It’s crucial for claimants to provide accurate and comprehensive information. This includes medical history, employment status, and limitations caused by the disability. Any inconsistencies or discrepancies in the application materials may raise red flags for the insurer, potentially leading to adverse decisions.
Inadequate Medical Documentation
Another reason for denial or termination of Long-Term Disability benefits is the lack of comprehensive medical documentation to support your claim. Insurers typically require detailed and consistent medical records demonstrating that you suffer from total disability as required under the policy. These medical records should reflect the severity and duration of the claimant’s disability. Whether the claim is based on physical or mental health conditions, comprehensive medical evidence is essential to substantiate the inability to work.
Failure to Meet Policy Requirements
LTD policies often contain specific requirements and conditions that claimants must fulfill to qualify for benefits. Failure to meet these policy requirements can lead to denial or termination of benefits. Some of the requirements include deadlines for submitting documentation or undergoing medical assessments. It’s essential for claimants to familiarize themselves with their policy’s terms and follow the prescribed procedures to maintain eligibility for benefits.
Navigating the complexities of Long-Term Disability benefit claims requires a thorough understanding of denial and termination process. We help our clients better understand the process and we advocate for their rights, which increases their chances of obtaining the benefits they deserve. You can find more information on our LTD page, or simply call us and let us help you.