Reasons You Are Denied Disability Insurance Coverage

Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

Short-Term Disability Insurance Denials

  1. Pre-Existing Conditions: If you have a medical condition before obtaining the insurance, your claim may be denied.
  2. Incomplete or Incorrect Information: Filling out the application or claim form inaccurately or incompletely can lead to denial.
  3. Lack of Medical Evidence: Insufficient medical documentation to prove your disability can result in a claim rejection.
  4. Policy Exclusions: Certain conditions or circumstances might be excluded from coverage under your policy.
  5. Delayed Claim Filing: Not filing the claim within the time frame specified by the policy can cause a denial.
Denied Disability Insurance

Long-Term Disability Insurance Denials

  1. Non-qualifying Disability: If your condition does not meet the policy’s definition of a long-term disability, your claim can be denied.
  2. Employment Issues: If you are not employed for a required period or are not working enough hours, it may affect your eligibility.
  3. Policy Limitations: Some policies have specific limitations or caps, which, if exceeded, can lead to denial.
  4. Surveillance Evidence: Insurance companies sometimes use surveillance to disprove a claimant’s disability, leading to denial.
  5. Failure to Follow Treatment: If you do not follow prescribed medical treatment, it could be grounds for denial.

Comparing Short-Term and Long-Term Disability Denials

CriteriaShort-Term DisabilityLong-Term Disability
Duration RequiredUsually up to 6 monthsMore than 6 months
Medical EvidenceLess stringentMore stringent
Employment CriteriaOften more flexibleStricter requirements
Policy ExclusionsCommon but variedMore defined and strict
Appeal ProcessGenerally simplerOften more complex
Denied Long Term Disability Coverage


Understanding the reasons for denial in both short-term and long-term disability insurance can help you navigate the complexities of your policy and improve your chances of a successful claim. Remember, accurate information, thorough medical documentation, and adherence to policy terms are key to avoiding denials.

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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, CRPC

Chartered Retirement Planning Counselor

Shawn Plummer is a Chartered Retirement Planning Counselor, insurance agent, and annuity broker with over 14 years of first-hand experience with annuities and insurance. Since beginning his journey in 2009, he has been pivotal in selling and educating about annuities and insurance products. Still, he has also played an instrumental role in training financial advisors for a prestigious Fortune Global 500 insurance company, Allianz. His insights and expertise have made him a sought-after voice in the industry, leading to features in renowned publications such as Time Magazine, Bloomberg, Entrepreneur, Yahoo! Finance, MSN, SmartAsset, The Simple Dollar, U.S. News and World Report, Women’s Health Magazine, and many more. Shawn’s driving ambition? To simplify retirement planning, he ensures his clients understand their choices and secure the best insurance coverage at unbeatable rates.

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

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