10 Common Reasons Long-Term Disability Claims Are Denied—and How to Fight Back

Long-term disability (LTD) insurance is designed to provide financial support when you cannot work due to a disabling condition. However, insurance companies often deny valid claims, leaving claimants in a challenging situation. Understanding the most common reasons for denials can help you take proactive steps to strengthen your claim and fight back if necessary.

Here, our nationwide claims attorneys at Disability Insurance Law Group explain.

Insufficient Medical Evidence

Insurance companies often deny LTD claims because there isn’t enough medical evidence to prove your disability. They may argue that diagnostic tests, treatment records, or physician statements are inadequate.

How to Fight Back: Work closely with your treating physician to provide detailed medical records, including test results, treatment notes, and a written statement from your doctor explaining your limitations.

Failure to Meet the Policy’s Definition of Disability

Each LTD policy includes a specific definition of disability, often requiring you to prove you cannot perform your “own occupation” or “any occupation.”

How to Fight Back: Review your policy’s definition carefully and provide evidence addressing these requirements. A vocational expert can help demonstrate how your condition limits your ability to work.

Pre-Existing Condition Exclusions

Many policies exclude coverage for disabilities caused by pre-existing conditions, which can result in a denial if the insurer claims your disability falls into this category.

How to Fight Back: Examine the timeline and details of the exclusion clause. You may have grounds to appeal if your condition develops or worsens outside the exclusion period.

Lack of Objective Evidence

Insurance companies often demand “objective evidence,” such as lab results or imaging scans, especially for conditions like chronic pain or mental health conditions.

How to Fight Back: To bolster your claim, provide supporting documentation from specialists, functional capacity evaluations (FCEs), or detailed daily activity logs.

Incomplete or Incorrect Paperwork

Even minor errors or missing documents in your claim application can lead to a denial.

How to Fight Back: Double-check all forms for accuracy and completeness before submission. Consider working with an experienced disability insurance attorney to ensure your application meets all requirements.

Insurance Company Surveillance

Insurers sometimes use surveillance footage or social media posts to argue that your activities are inconsistent with your claimed disability.

How to Fight Back: Be mindful of your actions in public and what you post online. If surveillance is used against you, clarify any misinterpretations of your activities with supporting medical evidence.

Disputes Over Medical Opinions

Insurance companies often rely on their own medical examiners or third-party reviewers who may disagree with your treating physician’s assessment.

How to Fight Back: Challenge their findings by highlighting inconsistencies, providing additional medical evidence, or requesting an independent medical examination.

Gaps in Medical Treatment

Failure to seek regular treatment can be interpreted as a lack of seriousness about your condition.

How to Fight Back: Ensure you follow all prescribed treatments and attend scheduled appointments. If treatment gaps exist, explain, such as financial hardship or lack of access to care.

Denials After Independent Medical Exams (IME)

Insurance companies often use IMEs to justify denials, as these exams are conducted by doctors chosen and paid for by the insurer.

How to Fight Back: Document your experience during the IME and provide additional opinions from your treating physician to counter any biased conclusions.

“Improvement” in Your Condition

LTD benefits may be terminated if the insurer claims you’ve shown improvement and can return to work.

How to Fight Back: Provide updated medical records showing your limitations. If the insurer relies on outdated or incomplete information, highlight these discrepancies during your appeal.

How Disability Insurance Law Group Can Help

Dealing with a denied LTD claim can be frustrating and overwhelming, but you don’t have to navigate this process alone. At Disability Insurance Law Group, our nationwide team of experienced attorneys specializes in helping clients appeal denials and secure the benefits they deserve. We understand insurance companies’ tactics and know how to build a strong case to challenge unfair denials. Contact us today by calling 954-989-9000 or online to discuss whether your LTD claim has been wrongfully denied. Together, we can fight for the benefits you need to move forward.