What Happens If Your Employer or Insurance Provider Misclassifies Your Disability?
On Behalf of Disability Insurance Law Group | | Disability Insurance PoliciesWhen you file a disability insurance claim, you expect a fair evaluation of your condition and the benefits you are entitled to under your policy. However, misclassification of your disability by your employer or insurance provider can result in delayed, reduced, or denied benefits—leaving you without the financial support you need. Whether your disability is incorrectly labeled as partial instead of total or your condition is placed in an exclusion category, a misclassification can significantly impact your claim.
Our nationwide claims attorneys at Disability Insurance Law Group know that understanding why these misclassifications happen and how to challenge them is crucial to securing the benefits you deserve.
How Do Employers or Insurance Companies Misclassify Disabilities?
Misclassification can occur for several reasons, including administrative errors, misinterpretation of medical evidence, or intentional tactics to minimize payouts.
Some common types of misclassifications include:
- Classifying a Total Disability as a Partial Disability
One of the most frequent misclassifications happens when an insurer downplays the severity of a disability and categorizes it as partial instead of total. If your policy covers total disability benefits, but the insurance company claims you can still work in a limited capacity, your payout may be significantly reduced—or denied altogether.
- Misapplying “Own Occupation” vs. “Any Occupation” Standards
Disability policies define coverage based on your ability to work in your job or any occupation. Some insurers misclassify claimants by stating they can work in a different field even when their disability prevents them from doing so. This misclassification is especially common when transitioning from own-occupation to any-occupation coverage after a set period.
- Labeling a Disability as a Pre-Existing Condition
Some insurance providers try to misclassify disabilities as pre-existing conditions to deny claims. If your insurer argues that your condition began before your policy took effect—even when medical evidence suggests otherwise—you could lose the benefits you rightfully deserve.
- Misclassifying Mental vs. Physical Disabilities
Specific disability policies impose limitations on mental health conditions, restricting benefits for conditions like depression, anxiety, and PTSD to 12 or 24 months. If your insurer misclassifies a physical disability as a mental health issue, they may wrongfully cut off benefits early.
- Improperly Categorizing a Work-Related Injury
Some policies exclude work-related injuries, assuming they fall under workers’ compensation. If your insurer wrongfully classifies your disability as work-related when it isn’t, they may try to shift responsibility to another insurance provider and deny your claim.
What Can You Do If Your Disability Is Misclassified?
If you suspect your employer or insurance provider has misclassified your disability, you can challenge the decision and protect your rights.
That includes:
- Reviewing Your Policy and Claim Determination
Request a complete copy of your disability insurance policy and carefully review the insurer’s reasoning. Pay close attention to how your disability is classified and whether it aligns with your condition.
- Gathering Strong Medical Evidence
Your medical records should support the correct classification of your disability. To strengthen your case, obtain detailed physician statements explaining why you cannot perform your job duties, as well as specialist evaluations if your condition requires expert medical insight. Additionally, a Functional Capacity Evaluation (FCE) can objectively assess your ability to work.
At the same time, a vocational expert opinion can help refute any claims by your insurer that you can work in another field. Comprehensive medical and professional documentation is key to proving the true extent of your disability and ensuring you receive the benefits you deserve.
- Appeal the Insurance Company’s Decision
If your disability has been misclassified, you can appeal the decision. Most disability insurance policies allow for a formal appeal process, but strict deadlines apply. Submitting additional medical documentation, legal arguments, and expert opinions can help overturn the misclassification.
Consult with Our Skilled Disability Insurance Claims Attorneys Nationwide
Misclassification is a familiar tactic insurance companies use to reduce or deny benefits. If your employer or insurance provider has misclassified your disability, you don’t have to accept their decision without a fight. The Disability Insurance Law Group has extensive experience handling wrongful disability denials and misclassifications. Our nationwide attorneys are dedicated to helping claimants like you secure the full benefits you deserve. Contact us today at 954-989-9000 or online for a free consultation.