Top Reasons for a Disability Claim Denial

Reducing the chances of a disability claim denial starts with completing the application correctly. Unfortunately, most claims contain errors. They are not…

Reducing the chances of a disability claim denial starts with completing the application correctly. Unfortunately, most claims contain errors. They are not checked and verified as accurate by someone who really is aware of all the laws, requirements and documentation that the adjustor, agent or representative that reviews the claim is looking for. Since most individuals don’t have first hand legal knowledge about what is needed for a complete, accurate claim, having an attorney familiar with disability insurance review your documentation is highly recommended.

Perhaps the biggest reason for any type of claim denial from private insurance, Veteran’s Disability, ERISA, SSI or SSD is lack of medical evidence to support the claim. The medical reports must completely and accurately demonstrate how the injury or illness has caused you to be unable to work or to reduce your ability to work. Unfortunately, many doctors don’t provide the specific language that the insurance company or Social Security is looking for. Typically this includes a clear statement that the specific disability you are being treated for is preventing you from returning to work. Often general physicians treat patients without a good understanding that an SSI, SSD or other type of disability claim will be made. Their records are, therefore, not comprehensive enough to support the claim.

Another common reason for a disability claim denial is incorrectly completing the required forms and applications, or making mistakes on the forms. This can be as simple as leaving a required section blank or incorrectly listing dates or appointments. While these types of denials are the easiest to complete they do hold up the processing of your claim. With very complicated forms it is easy to make these types of errors and omissions and attorneys familiar with the forms can quickly spot any issues that need to be corrected.

In some situations workers that have filed more than once and have been denied on that claim will also be denied on a new claim. This is particularly problematic if the two claims are similar or may be related. It is, therefore, essential to appeal any and all denials to the full extent possible. If you have filed before and have been denied and not followed through with an appeal be sure to speak to a disability claim attorney before filing the current claim. Many times filing the appeal can help prevent a disability claim denial provided you are in the allowed time frame for the appeal.

In some situations you may have sought the services of several doctors and may have chosen to not follow the original or subsequent doctor’s treatment plan. If this information is in your records you may be denied as the claims adjuster may see your lack of following the treatment plan as contributing to the disability. Having the correct documentation from your current doctor indicating that the treatment plan you followed is the best option for your health condition will be essential to prevent this type of denial.

Avoiding a disability claim denial is possible, even with very complex and complicated types of disability. The key is to avoid the common pitfalls, have correct medical documentation and ensure that all paperwork is accurate with the original submission. Working with a disability attorney to review all the information and provide recommendations for how to most accurately document your medical case is a great investment in ensuring that you won’t be denied the benefits you deserve.