Long-term disability insurance is designed to help you financially if you are injured and unable to work. These policies are usually governed by the Employee Retirement Income Security Act (ERISA), and there are many rules and regulations when filing an ERISA disability claim, which means there's a lot of reasons your claim could get denied. Check out three common reasons why your ERISA disability claim could get denied.
Your Disability Doesn't Match the Policy's Definition
Different disability policies define the term "disability" differently. Some policies consider you disabled if your injury prevents you from doing just your job. For example, if you work in a warehouse, moving heavy objects all day, and you injure your back, you may no longer be able to do your job because you can't lift heavy objects. You have no problem doing other actions, such as office work, but because your policy finds you disabled if you can't perform your job, you are considered disabled.
Other policies, however, are stricter. Under these policies, to be found disabled, you must be unable to perform any job. So, in the example above, you wouldn't qualify for disability because there are some jobs you can still do.
There Isn't Enough Medical Evidence
Of course, to qualify for disability insurance, you need to have a disability, and you need to prove it. The best way to do this is to go see your doctor. However, even after seeing a doctor, if your doctor's findings don't prove a disability, your claim will get denied. Also, if the doctor finds that the injury was a pre-existing condition and the insurance policy has a pre-existing condition waiting period, you may also not qualify.
While applying for your disability benefits, it's important that you continue to see your doctor and seek treatment. If you only see your doctor once (or not at all) and then stop seeking treatment, your insurance carrier will view that as a red flag and assume that your injury must not be that severe if you aren't even trying to get help.
Your Disability Doesn't Last Long Enough
Many disability policies have an elimination period. This is just a waiting period between the date of injury and when you receive your benefits, and they can last between 30 and 365 days. In some cases, they work as deductibles, so instead of paying a deductible, you have to wait a specific number of days before you can get your benefits.
If, however, during this elimination period, you get better, you won't be rewarded any disability benefits. Even if you were legitimately disabled for six months, but you get better while the elimination period is still active, you don't get benefits. The insurance carrier may also deny or claim if your doctor's records indicate you will get better before the elimination period ends.
Disability insurance can be a lifesaver if you are unable to work, but as with any type of insurance, there are rules to follow, and your claim can get denied. If you've been injured, and aren't sure what to do, contact a disability lawyer in your area.