Faqs About A Disability Insurance Claim Denial

Posted on: 15 June 2016


A denial of your disability insurance claim does not necessarily mean the end of the road. You can file an appeal to request a review of the decision. Before filing an appeal, here is what you need to know. 

Why Was Your Claim Denied?

A claim denial can occur for several reasons. For instance, some claims are denied because there is a lack of medical evidence. Lack of medical evidence could mean that the insurance company did not receive enough medical records from your medical care providers to make a decision. 

It could also mean that you did not receive regular medical treatment that is consistent with your disability claims. For instance, if you were supposed to attend physical therapy but did not, the insurance company could argue that your injuries were not serious enough for you to follow the doctor's orders. As a result, you are not entitled to receive benefits. 

Denials can also result from simple mistakes, such as failing to follow the deadlines set by the insurance provider.

Whatever the reasoning, the insurance company has to include it in the denial letter that you receive. You can use the reasoning to help shape your appeal. 

How Can You Appeal?

If you are planning to appeal, make date on the denial notice. You must file your appeal within a certain number of days following the date on the denial notice. If not, you could possibly forfeit your right to appeal and will have to start the process over again. The number of days can vary based on the type of disability insurance you have. How long you have is included on the notice. 

If the insurance company denied your claim based on a lack of evidence, you need to work on building up the amount of evidence you have. For instance, you can ask your doctor to write a statement that details your impairment and states that you are physically unable to work.

You can also see a specialist if you have a condition that requires more specialized care. For instance, if you have a heart condition, a cardiologist's report could help build your case. 

If you made a mistake, such as missing the deadline, you need to contact the insurance provider and find out whether or not you can continue with the claim. If so, the provider can explain what you need to do to correct your mistake. If not, you might have to start the process again. 

Appealing a denial from and insurance company can be challenging, so working with an experienced attorney could be the best decision.