Many claims for long-term disability (LTD) insurance benefits are refused when you submit your application. It’s important to know that even if your disability insurance claim is originally granted and your case has conditions that qualify for LTD, your insurance company has the right to cancel or cut off your benefits at any time for any reason.
Long-Term Disability Claims Refusal and Termination Reasons
- As a result of a pre-existing medical issue
When a pre-existing condition is the primary cause of a disability that begins before the end of the first 12 months after your effective date of coverage, no benefits will be paid for that disability. If you were diagnosed with a condition or injury within three months of the start of your insurance coverage, it is considered pre-existing. The ailment or damage was treated, cared for, or provided for by a medical professional.
- Absence of Your Social Security Benefits Application
You may be needed to apply for SSD if you are granted long-term disability payments. The insurance company’s payout of disability payments will be reduced. It is common for insurance companies to only pay the difference between the Social Security Disability benefit amount and the long-term disability benefit amount if a claimant is accepted for Social Security Disability (SSD). The insurance company will save a lot of money this way. If you don’t comply, your disability insurance claims may be terminated; therefore, if your claim is refused, you should appeal it
- Independent Medical Examination
When a long-term disability claim is refused after an independent physician consultant report or independent medical examination, your insurance company analyzes the case to determine why. If the insurance company thinks an “independent physician consultant” (IPC) can better assess the validity of your disability claim, you may be referred to an independent medical evaluation (IME). This is an examination performed by medical professionals who aren’t currently involved in your situation. In both cases, you may expect an “independent” doctor report that questions your own treating doctors’ judgments and claims that your medical evidence does not match the criteria of impairment.
It is possible to be rejected or discontinue long-term disability coverage for various reasons. Regardless of whether you’re covered by an ERISA-governed group plan or individual insurance, it’s crucial to check your policy periodically for reasons why your benefits could be canceled.