Do Most Disability Claims Get Denied the First Time?

Long Term Disability Insurance Claims, whether private or individual polies or group LTD policies governed by ERISA, are frequently denied at two key points – when they are first filed, or after the first 24 months of benefits being paid (often the transition point of the definition of disability from own occupation to any occupation).

Hard to say which is worse  – getting denied outright or after two years of receiving long term disability insurance benefits and having come to rely upon the benefit for your adjusted lifestyle.

How can you prepare and protect your long term disability insurance claim?

Since these claims are expensive liabilities to long term disability insurance companies, expect a challenge to your claim. Start by treating the disability claim differently than any other insurance claim. The long term disability insurance company is not like a health insurance company or homeowner’s insurance company, where claims are usually one-time events and limited in the cost to the insurance company.

Consider the value of your claim over an extended period of time to understand why it’s so important to be prepared to fight for the claim with a robust claim application. If your policy pays $8,000 in benefits per month, your cost to the disability insurance company is $96,000 a year. For a claimant who is 55 years old, if your policy pays to age 65, you have as much as $960,000 at risk if your claim is denied.

With a fuller understanding of the long-term value of the claim, you can see why the disability insurance company is motivated to deny paying any claims, especially if you multiply this by the millions of people who own disability insurance policies. 

This exercise also shines a light on the value of working with an experienced disability insurance attorney. The risk of your claim not being paid, or being paid for two years and then terminated, is simply too great. 

Assembling medical reports prepared by your treating physician is critical to the success of your claim. But it is not as simple as gathering up as many reports as you can get from your doctor’s office or downloading them from a healthcare provider’s portal. Ensuring the records can support your claim is vital.

First, are you seeing the appropriate doctor for your claim? A person with a cardiac condition, for instance, needs to be under the treatment of a cardiologist. If you have Fibromyalgia, your care needs to come from a rheumatologist or other specialist, not a general practitioner. The insurance company will question the seriousness of your disability if you are not being treated by a specialist, or if the treatment is not appropriate for your condition.

Next, what kind of medical tests have been done to prove your diagnosis and the severity of the impairing symptoms?  Not all doctors understand the level of specificity being sought when submitting an LTD claim. There are certain gold standard tests preferred by disability insurance companies. Unless your doctor has a double life as a long term disability insurance lawyer, they are not likely to know what these tests are. Disability attorney Jason Newfield has relationships with a national network of medical specialists who are able to provide his clients with the tests the disability insurance companies are looking for and can help to support a claim for benefits.

Another factor sought by the disability insurance claims reviewer is the length of treatment. If a person submits a claim after only a few visits to a doctor, the claim will be questioned for whether or not the claimant has provided the treatment enough time to be effective.  In other words, the disability insurance company will look for ways to discredit your claim and deny your benefits. Going into the process with a well-known disability insurance attorney gives you multiple advantages.

After a claim is paid initially, the transition of the definition becomes the next point of challenge. Strategies employed to help navigate this process include securing vocational expert support and further medical testing, often proactively.  

Having more than two decades of experience in representing claimants with applying for disability benefits, fighting back when claims have been denied or wrongfully terminated gives Jason Newfield’s clients an advantage over claimants who attempt to file claims on their own. Having seen the issues involved with these claims, we can prepare a claim to help make it difficult to challenge, providing all of the needed support when the claim is submitted. 

If you or a loved one is about to file a claim for disability or if your claim has been denied, call Newfield Law Group to learn how we can help. The call is free and there’s no obligation. Call today at 877-406-7883.

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