Why You Might Be Denied Disability Insurance

Shawn Plummer

CEO, The Annuity Expert

In an ideal world, insurance would act as a safety net, catching us during our most vulnerable moments. However, many individuals are perplexed and defeated when faced with denied disability insurance claims. Especially when this denial is related to long-term or short-term disability coverage, the sense of betrayal can be overwhelming. But understanding the landscape of denial and the subsequent steps you can take will empower you to approach the situation from the standpoint of knowledge and strategy.

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The Reality Behind Denied Disability Claims

Insurance isn’t just a business; it’s a complex maze. Understanding the most common reasons for denial is pivotal to navigating it successfully.

  • Misunderstanding or Miscommunication of the Medical Condition: A common reason for denying long-term disability is a misinterpretation of the medical condition. For instance, you might think your ailment is debilitating, but the insurance company might view it as a minor impediment.
  • Example: Jane, a software developer, suffered from chronic back pain. Although she felt it impeded her ability to work long hours at a desk, her denied long-term disability insurance coverage cited that her job could be modified to alleviate strain, thus making her condition not severe enough.
  • Insufficient Medical Evidence: At times, long-term disability insurance gets denied because there isn’t enough medical proof to support the claim. Regular doctor visits, treatments, and up-to-date medical records are vital in substantiating your disability claim. A thorough documentation of symptoms and a precise diagnosis, such as fibromyalgia or rheumatoid arthritis, can strengthen the credibility of your claim.
  • Example: Peter, an accountant, suffers from a mental health disorder. He felt it impeded his cognitive abilities but rarely visited mental health professionals. As a result, his long-term disability claim was denied due to insufficient evidence.
  • Inconsistencies in Application Information: Both claims’ authenticity denied short-term and long-term disability claims can arise from inconsistencies in the application. An oversight or inconsistency can raise red flags, leading insurance providers to question the claim’s authenticity.
  • Example: Carla claimed she couldn’t work due to her disability, yet her social media showed her participating in strenuous activities. This discrepancy led to her denial of long-term disability.
Denied Disability Insurance

Short-Term vs. Long-Term Disability Denials: The Distinct Differences

It’s not uncommon to wonder, “Why would short-term disability be denied, and how does it differ from the denial of long-term disability?”

  • Duration of Disability: One key distinction is the expected duration of disability. Short-term disability is typically for ailments expected to resolve within months. If recovery’s anticipated sooner than claimed, short-term disability might be denied.
  • Example: Lisa had a minor surgical procedure and claimed a short-term disability. However, her doctor’s records indicated a swift recovery, and her claim was denied.
  • Severity and Type of Ailment: The nature of the ailment can also influence the type of denial. Some conditions might be considered not severe enough for long-term disability but may qualify for short-term.
  • Example: Sam had a severe flu, rendering him unable to work for two weeks. While he was denied long-term disability coverage, he was eligible for short-term disability benefits.

Paving the Path Forward After Denial

Facing a denial, whether of short-term or long-term disability insurance, can be daunting. But remember, it’s not the end of the road.

  • Appeal with Solid Evidence: Gather as much medical evidence as possible. Regular doctor’s visits, expert testimonies, and consistent medical records can bolster your case.
  • Consult with Legal Experts: It might be beneficial to consult with an attorney specializing in disability claims. They can guide you through the intricate process and enhance your chances of overturning the denial.
Denied Long Term Disability Coverage

Next Steps

Being denied disability insurance, short-term or long-term, can feel like a massive blow. But by understanding the reasons behind these denials and taking informed steps, you can arm yourself with the best possible chance of overturning the decision. Remember, knowledge is power; it’s your best ally in the intricate maze of insurance claims.

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Frequently Asked Questions

Why do people get denied long-term disability?

People get denied long-term disability due to insufficient medical evidence, not meeting the policy’s definition of “disability,” missed application deadlines, prior existing conditions, or discrepancies in the claimant’s activities and reported limitations. Applicants must understand their policy and provide comprehensive supporting documentation thoroughly.

Why would disability insurance be denied?

Disability insurance may be denied due to insufficient medical evidence, not meeting the policy’s definition of “disability,” pre-existing conditions, application errors, or discrepancies between claimed limitations and observed activities. Understanding and adhering to policy requirements is crucial when applying.

Is disability usually denied the first time?

Yes, many disability claims, especially for Social Security Disability Insurance (SSDI) in the U.S., are often denied on the first attempt due to reasons like insufficient documentation, application errors, or not meeting specific criteria. It’s common for applicants to succeed on appeal or after providing additional information.

What happens if you get denied disability twice?

If denied disability twice, applicants can appeal again. In the U.S., after an initial denial and reconsideration denial for SSDI, the next step is a hearing before an administrative law judge. It’s essential to gather more evidence, consult with an attorney, and prepare for a more extended process.

Do most disability claims get denied?

Yes, a significant number of disability claims, particularly for Social Security Disability Insurance (SSDI) in the U.S., are initially denied due to reasons like insufficient evidence or not meeting the criteria. Many applicants succeed with more robust documentation or legal representation upon reconsideration or during the appeal process.

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Shawn Plummer

CEO, The Annuity Expert

I’m a licensed financial professional focusing on annuities and insurance for more than a decade. My former role was training financial advisors, including for a Fortune Global 500 insurance company. I’ve been featured in Time Magazine, Yahoo! Finance, MSN, SmartAsset, Entrepreneur, Bloomberg, The Simple Dollar, U.S. News and World Report, and Women’s Health Magazine.

The Annuity Expert is an online insurance agency servicing consumers across the United States. My goal is to help you take the guesswork out of retirement planning or find the best insurance coverage at the cheapest rates for you. 

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