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Why do long-term disability benefits get denied?

Employees who pay for long-term disability (LTD) benefits are often shocked to learn the insurance company refuses to pay when a disability strikes. Some of the most common reasons employer-provided LTD benefits get denied include:

  • Insufficient medical evidence: It may be plain to you and your loved ones that you are disabled, but you must have documented evidence if you wish to prove your disability in a legal context. Get treated regularly and obtain records from objective tests such as X-rays, MRIs and CT scans whenever possible to gather strength for your claim. A doctor's statement can also prove beneficial.
  • Failure to follow doctor's orders: If your doctor tells you your disability prevents you from jogging, or lifting 20 pounds, or performing some other physical activity, then you shouldn't do so, even on a day when your symptoms are better than others. Insurance companies investigate disability claimants. If you are observed doing something that suggests you are not disabled, it could prove very difficult to appeal a denied claim.
  • You don't meet the policy's definition of disabled: Some policies have excluded conditions. Some have specific language concerning a disability applicant's ability to perform the duties of their own occupation versus any occupation. An experienced LTD benefits attorney can analyze the terms of your agreement to determine your benefits are being unfairly denied, or if the insurance company stands on firmer ground.

Employer-provided LTR benefits are governed by the federal Employee Retirement Income Security Act (ERISA). If your disability claim was unfairly denied, you can benefit from talking to an attorney who is experienced handling this type of employment law matter.

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