Photo by Meruyert Gonullu: https://www.pexels.com/photo/girl-in-wheelchair-talking-with-friend-7698665/
Getting permanently injured on the job is possible in any industry. Whether you’re a plumber or physician, own occupation disability insurance can provide coverage in these unforeseen situations. That said, insurance companies sometimes deny long-term disability claims. Here are three basic reasons why this happens.
1. You Failed to Provide Claim Notice and Documents Promptly
When you submit a claim for disability insurance, timeliness is a recurring problem. Insurers count on the prompt notification and follow-up from disability lawyers of policyholders. Claim handlers may occasionally reject claims when you don’t respond to requests inside the allotted window.
The requirements for timely submission of group disability claims covered by ERISA are:
- Evidence of impairment
- Documentation delivery
- Updates, tests, chart notes, and prescription drugs
- Answers to questions from insurers
- Additional claim filing dates and requirements
Theoretically, insurers will only reject your claim due to timing difficulties if your tardiness compromises their capacity to handle claims and protect their legal rights. But, if you miss a deadline, your claim may be denied or delayed, no matter how legitimate.
2. Your Claim Documentation Was Insufficient
Insurance companies decide whether to pay a claim based on your disability documentation. They need enough details to decide if you have a long-term handicap, such as:
- Medical reports, chart notes, medications from the pharmacy, and objective tests
- Report narratives from doctors
- Employment background and income
- Medical history
Some insurance providers offer claim forms to help you with the documentation procedure. Even if they don’t deliver forms, the terms of your insurance require you to give them the necessary paperwork. If you or your doctor forget to deliver proof of impairment for your disability, the insurance company may think about rejecting your claim.
3. You Have An Existing Illness
Benefits for disabilities resulting from, contributing to, or being related to a pre-existing ailment are typically not covered by long-term disability policies. Plans classify an illness as pre-existing if you had symptoms, used medicine, sought treatment, had an exam, or spoke with a doctor within 3 to 12 months before the start of your insurance.
This pre-existing condition coverage exclusion is not unbreakable. The clause might not apply under some plans if you worked actively and continuously for a set amount before incapacitating. When your disease has various symptoms and has been diagnosed with more than one condition, the certainty of a pre-existing condition claim denial becomes hazy.
Getting a notice regarding your claim being denied by your insurance provider can be frightening. Insurance corporations employ ambiguous language in the “fine print” of the insurance contract, subjective terminology like “complete disability,” and other uncontrolled assessments to refuse compensation. Therefore to save yourself from any uncertainty, read out the guidelines mentioned above and prepare your case accordingly to minimize your chances of being rejected by the insurance company.