How an Insurance Company Decides Long Term Disability Claims

There is a standard process for an insurance company to decide in favor of or deny long term disability insurance claims. Knowing this process can help you get your claim approved.

How Are Claims Decided?

Basically after the claim for long term disability is filed, then all of the information is reviewed:

• A request for additional information may be submitted to the claimant with a deadline for return on a specified date. 
• If a request for additional information is made, the claimant should follow-up and provide any additional information needed.  Should the claimant not submit the requested information on time, their claim for long term disability benefits may be denied.

Medical Exams

The insurance company may request that an additional medical exam take place by their independent doctor.  You may want to opt against that because it could possibly be used in denying your claim.  If this request is made, it might be a good idea to consult with a disability claims lawyer. 

The Decision

Nonetheless,  after careful investigation, the disability insurance claims representative may either decide to grant you long term disability benefits or deny your claim. If the claim is denied, then you have the right to appeal the decision in writing.  If you decide not to appeal the claim, the end result can be an irreversible claims denial.  This would prove detrimental in the long run, if you decided to fight it later on.

Unfortunately, many of the claims reviews are not done impartially.  As a result of that many claims are denied.  This is why disability attorneys are retained.

Problems with the Process

There are several problems with the decision process regarding long term disability insurance claims. 

• The insurance company has the right to say that your disability symptoms are completely subjective, which simply means that the symptoms alone are not objective evidence of a disability. 
• Another pressing issue is that there is no standard protocol for accepting or rejecting an insurance claim. 
• Finally, when claims workers are in the review process, it is not uncommon for them to ignore concrete medical evidence and opt to use their own judgment instead.  This has unfortunately become increasingly common. This is yet another reason why disability attorneys are hired by claimants.  This is not to say that all insurers or claims workers practice unprofessional practices.  It is, however a tactic employed by many insurers that enables them to deny long term disability claims.

Getting Help

If your long term disability claim has been denied and you have appealed the ruling, you might consider speaking with a disability attorney about the claim and discussing your options.