There are a number of reasons why insurance companies will flat-out deny your application for disability insurance benefits or terminate your coverage. We have compiled a non-exhaustive list of reasons why the insurance company will deny or terminate your application for benefits:
1. Documentary errors – if the application for benefits was incomplete or filled out in error. It may be best to consult with a disability lawyer in advance of submitting your application to ensure that it has been completed accurately;
2. Pre-Existing Condition – if you were sick or disabled prior to developing the condition that has prevented you from returning to work, the insurer may deny your coverage on the basis of pre-existing condition;
3. Lack of Medical Evidence – the insured has an obligation to produce sufficient medical evidence to prove that they are disabled from performing the essential duties of their occupation. If the employee does not provide enough medical evidence, the insurer will deny your claim on the basis of “insufficient medical information”;
4. Surveillance Evidence – insurance companies, believe it or not, send out private investigators to conduct surveillance on employees that have submitted applications for disability benefits. If your actions are contrary to the evidence submitted to the insurer, they may deny your claim;
5. Meeting the ‘definition of disability’ – the typical disability insurance policy contains a 24-month ‘own occupation’ period, whereby the insured qualifies for disability benefits if they are unable to perform the essential duties of their own occupation. After that time, the definition changes, and the employee will only continue to receive benefits if the medical evidence can establish that you are disabled from performing ‘any occupation’ commensurate with your education, skills, and experience.
If you are seeking an experienced disability lawyer to discuss your case, please give us a call today for a free consultation.