What to Do If Your Long-Term Disability Claim Is Denied?

By sarose

February 18, 2025 4 Min Read

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When someone is already dealing with a long-term disability, it makes him more stressed when his claim gets denied. The worst, even those who are genuinely eligible for the perks may also have to face a denial. If you are one of those who is dealing with this, I am here to make you understand the options you have and how you can move forward.

Denied Claim? Here’s What You Need to Do Next

Review the Denial Letter Carefully

Just after you receive a denial, carefully go through the letter from your insurance provider. The letter will have all the reasons why your claim for long-term disability was denied. Some of the most common reasons for the denial could be –

Not sufficient medical evidence

There are chances that your insurance company may believe that the documentation you have submitted does not completely support your inability to work.

Failure to meet the policy requirements:

Did you know? Each LTD policy has its terms and conditions. And if you fail to meet these terms and conditions, chances are, your claim will be denied.

Pre-existing conditions

Some policies include clauses that exclude coverage for conditions that existed before you applied for LTD benefits.

Understanding the reason for denial is necessary while going forward with your next steps.

Gather and Organize Your Medical Records

If your claim for disability benefits was denied on the grounds of insufficient medical evidence, you will have to gather and organize your medical records again. You can do so by getting in touch with your doctor and asking him for a detailed report. The detail should outline the severity of your medical condition and how it stops you from working at your maximum ability. I advise you to do it at the earliest because up-to-date records will support your case.

But if you have already submitted your records, you can request your physician to give you additional documentation or a more detailed statement to address those issues mentioned in the denial letter.

Appeal the Denial

Most of the time, the very next step after the claim has been denied is to file an appeal. Of course, insurance companies have an appeals process, but each policy is unique. You have to check your policy to confirm the requirements for appealing the decision. However, if you don’t know how to approach the appeal, here are the points that will help you:

You can request a copy of your claim file. You are allowed to do so. By doing so, you can better understand why the insurer may have denied your disability claim and help you in your appeal.
You can even consider submitting additional evidence. If new medical evidence or documentation can support your claim, why not submit it during the appeal process?
Last but not least, you must follow all the deadlines. You have to specially take care of the timeline you have been given to file an appeal. But if you fail to meet the deadline, chances are you will not be able to challenge the denial.

An appeal might not guarantee that you’ll win, but it’s often worth pursuing to see if a reconsideration is possible.

Consult an Attorney or Disability Advocate

Disability claim denied? I know it is not a piece of cake to deal with the insurance providers during such challenging times all alone. You will need an attorney or a disability lawyer by your side who specializes in LTD claims. It is easy for a lawyer to understand your rights and provide you with the right guidance on how you can best approach your appeal.

Wondering what a lawyer will do? Here is what you can expect him to do for you:

He will gather all the required evidence
Communicate with your insurance company
Represent your case in a way that the chances of your success increase

But wait! Are you not sure if you should hire a lawyer or not? It is better to go for a professional consultation that will clarify your options.

Understand Your Policy’s Definitions

There is no denying in saying that LTD policies may vary significantly. And it’s just the fine print that makes all the difference whether your claim will be approved or disapproved. Some of the key elements of your policy to review are as follows –

Definition of disability

Your policy will define what qualifies as a disability and whether you meet the requirements. Some policies define disability as an inability to perform your “own occupation,” while others may require that you cannot perform any “gainful occupation.”

Length of benefits

Some policies offer LTD benefits for a specific period. For instance, some have a period of 2 years, while others provide them until retirement age.
Look for clauses about exclusions, such as pre-existing conditions or specific illnesses not covered by the policy.

Consider Legal Action

Just in case your appeal is not successful and you have a gut feeling that the insurance company is wrongfully denying your claim, you should explore the possibility of legal action. I understand that suing an insurance company is not an easy task, but this could be the best if nothing else is left and you have to secure the disability benefits you deserve.

The Final Verdict

You don’t have to be discouraged if your long-term disability claim gets denied! It isn’t the end of the road, you have several options waiting for you so that you can get the perks you deserve. All you have to do is: