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What are common reasons given for denials?

What are common reasons given for denials?

Among the many reasons that insurers give for denying disability insurance, the following are fairly common.

There is no objective evidence in support of total disability.

This is a reason that is very common for disabilities caused by chronic fatigue syndrome, depression, soft tissue injuries and the like. If your denial letter says this, you should check the language of your policy or plan. If the plan does not specifically require objective evidence in support of disability, some courts have ruled that this is not a sufficient reason for approving disability insurance.

In any event, you should make sure that your doctor’s letter does describe any objective evidence establishing your disability. Disability insurance wants to see such objective evidence from a medical professional. At a minimum your doctor should render an opinion as to whether your symptoms are consistent with your diagnosis.

We have spoken with your doctor and he agrees with us.

Many insurers send out letters saying that they have spoken with your doctor and that he or she agrees with us. If your disability insurance denial letter says this, check with your doctor. In many cases it is just not true. If your doctor never said what they said, have your doctor write a letter correcting the record.

Your job was sedentary and you are not disabled from performing sedentary work.

This is a common reason for disability insurance denial when the reason for disability is fatigue and/or pain. It is hard to quantify fatigue and pain. The insurers take the position that your job does not involve a lot of physical activity so that you can still do it despite your fatigue and pain. If this is the denial you receive, it would be very helpful if you could obtain a letter from your doctor opining that you cannot work even in a sedentary position. You may also want to obtain a description of your job’s duties from your employer. This could help demonstrate that your job was not sedentary or caused significant stress.

We had your records reviewed by Doctor X. Dr. X says you are not disabled.

If you receive this type of disability insurance denial it is important to request a copy of the report of Dr. X. Once you receive it, you should have your doctor write a report contesting its findings. One way to attack the report is to argue that your condition cannot be evaluated without a physical examination. This argument, of course, sets you up for an independent physical examination. Before making it, you have to assess the risks and benefits of such an examination.

You are no longer disabled.

All long term disability insurance plans and policies periodically review the cases of individuals currently receiving benefits. If you receive a denial which says you are no longer disabled, you have the right to appeal the denial just like you did at the initial application.

These discontinuations can often be attacked by demonstrating that your condition has not improved.

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