Some common reasons for denials of long term disability insurance benefits are outlined below.

There is a pre-existing condition.
Some disability insurance policies will exclude a pre-existing condition for up to 12 months.  A pre-existing condition is generally defined as a medical ailment that was treated within a specified number of months before coverage began.  

Lack of objective medical findings.
Insurers want to see, what they deem, clear medical evidence that supports your disability.  The objective findings may include x-rays, mri's or blood tests. Basically, an insurer is looking for what they see as concrete proof that there is a disability.  

You can still perform your job.
A claims reviewer will thoroughly scrutinize your ability to perform your job duties.  The reviewer will research the definition of your job and the related tasks as defined by the national economy.  A claim can be denied on the basis of a generalized description of your job requirements, even if your job is more strenuous.  If you have been denied disability insurance benefits based on the reviewer’s findings, be sure to request an explanation.  

Symptoms are self-reported.
Self-reported symptoms, which can include headaches or fatigue, are hard to document through objective findings and insurers may deny a claim on this basis.  If an insurer denies a claim on this basis, you may be able to challenge the decision.

Not pursuing physician care and proper medical treatment.
Many insurers require that you are under the regular care of a physician.  However, policies are not always clear on the definition of “regular care”.

Long term disability insurance claims are complicated.  An experienced disability insurance claims attorney can assist you if you have been denied benefits.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
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