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Common Mistakes That Lead to Long-term Disability Denial

The process of filing a long-term disability claim is an arduous task from the start — and insurance companies will comb through every inch of your claim to find a reason to put a “denial” stamp on it if they can. While there are a host of reasons why insurance companies deny long-term disability claims, some can be avoided. Here are some common mistakes to you should be aware of when filing for a long-term disability claim:

Medical Documentation/Evidence

Insurance companies will want access to your medical records and claimants hold the burden of proof in a long-term disability claim. Having a lack of medical documentation could put your case in jeopardy and ultimately lead to a denial. Here are some things to consider:

  • Submit medical records in a timely fashion- If the insurance company does not receive your records, they will deny your claim. Be sure to provide medical records from all relevant treating providers and according to the proper timelines. If you are unsure about when to submit your records, it’s best to consult a long-term disability lawyer to guide you in the right direction.
  • Keep good medical records - documentation of your medical condition is vital and can make or break your claim. You’ll need more than just a doctor’s note stating you are disabled. The insurance company will look at two types of medical evidence — objective (test results, x-rays, blood tests, etc.) and subjective (patient complaint such as pain or fatigue). It is important for the subjective complaints to be supported by objective evidence because the insurance company will view the subjective complaints as more credible.
  • Choose the Right Doctor - While each component to your long-term disability claim is important, ensuring you choose the right doctor that supports your claim is vital. Your doctor will receive numerous questionnaires and documents from the insurance company regarding your claim. If your doctor does not agree that you are unable to work, the claim will most likely be denied. Talk to your doctor first, before filing for long-term disability benefits to ensure they support your claim.
  • Doctor statements - While medical records are important, statements from your doctor is another critical piece to your claim. Having a doctor that is cooperative is vital to the success of a long-term disability claim. Your doctor should be well-versed in filing paperwork, meeting critical deadlines and have experience in dealing with insurance companies in long-term disability claims.
  • Independent Medical Exam (IME) - Your insurance company will have you meet with a doctor to perform an IME. These doctors are frequently used by insurance companies and typically the results remain in favor of insurance companies. IME doctors are extremely knowledgeable about long-term disability claims. When on an IME exam, ensure you do the following:
    • Take as many detailed notes from your exam as possible, to ensure you get the best outcome. For example, how long the exam lasted, what questions the doctor asked and what tests were performed.
    • Obtain a copy of the IME report.
    • Review the IME report for any questionable information and consult with your disability attorney.

Your Daily Activities

Many people who have filed a long-term disability claim are often concerned about insurance companies surveilling their personal activities. While it may seem like a sneaky tactic, insurance companies do spy on claimants in many different ways. They will attempt to use any information they receive to deny your claim. Here’s how to protect yourself:

  • Red Flags - you will be required to fill out a form called an “activity log” asking for information about your activities for the upcoming weeks. The purpose of the activity log is to match your activities to their surveillance. You may pose a “red flag” to insurance companies and may be more likely to be spied on for the following reasons:
    • You’re younger
    • Have a substantially valued claim
    • Appealing a denied long-term disability claim
  • Internet Searches- Insurance companies will use internet searches and background checks to find out information about you. Just a simple google search can give the insurance company the following information:
    • Your business website
    • Personal blogs
    • Comments and activities on other sites and blogs
    • Published content and articles that have been written about you
  • Social Media - One of the easiest ways for the insurance company to find information about you is through your social media activity. They will look for information that may indicate you are performing activities in which you have reported to them that you cannot do. It's critical to review your social media activity and privacy settings.
    Even if your social media account is completely private, keep in mind, they could also find out information by finding your friends and family member accounts that may have pictures or posts about you. Here’s what they may look for:
    • Employment status
    • Hobbies
    • Relationship status
    • Your place of residence
    • Check-in activity
    • Photographs of recent vacations/ family gatherings
  • Videos and Photographs - Insurance companies commonly use video surveillance for spying on claimants. They may park outside your home, or follow you to observe if you are doing any activities that contradict your claim. Here’s what they may be noting:
    • How long you were outside your home
    • Whether you lifted or carried anything
    • If you wearing high heels or sneakers
    • If you were wearing a brace or using a cane
    • It was apparent that you had difficulty moving around

Filing A Claim Without an Attorney

Embarking on a long-term disability claim without an attorney at your side can put you in a bad position. An experienced long-term disability lawyer knows how insurance companies work and what they look for to deny a claim — especially when it comes to navigating the complications of pre-existing conditions.

  • Situations Involving Pre-Existing Conditions - Most long-term disability policies contain a clause excluding payment of benefits for conditions that are deemed “pre-existing” under the insurance policy. However, insurance companies take a very broad approach to interpret pre-existing clauses outlined in policies and can use this to deny a claim. They will often stretch the exclusion to apply to cases in which it isn’t warranted. In this case, it’s best to seek the assistance of an attorney to help you with an appeal as the area of pre-existing conditions in a long-term disability claim is a tricky one.

Filing a long-term disability claim can be taxing and stressful, especially if you are not experienced in navigating through the process. Our disability insurance attorneys can guide you through every step and handle all the “red tape” so you can focus on your health. Don’t face the insurance companies alone. Contact Dabdoub Law Firm at (800) 969-0488 today to learn more.