Common Reasons Why a Disability Insurance Claim Is Denied

More often than expected, many disability insurance claims are denied in the initial stage. When this happens, different reasons for its rejection play in mind.

Here are some of the common reasons why a disability insurance claim is denied:

1. Lacks objective findings

The social security reviewer who looks into your application may dismiss your claim on the grounds that it lacked the so-called "objective findings" to substantiate your disability claim. Hard medical evidence such as blood tests, MRI results, x-rays, etc. of your physical or mental condition are sometimes needed by the claims reviewer to decide on your claim. Lack of this vital information often becomes an obstacle in the approval of a claim.

However, some disability insurance policies do not require the absence of objective findings as basis for the denial of a claim. In this case, you will need the help of a disability lawyer to help you pursue your claim.

2. You are not disabled from your occupation

A claim reviewer may also deny your claim on the basis that you are not disabled as defined in your occupation. You may be experiencing stress at work, but the claim reviewer will not consider this as disability required by your occupation.

Sometimes he may even use inaccurate job description to determine your disability and use it as basis for denial. In such case, you must get an explanation from the claim reviewer and consult a disability lawyer.

3. Pre-existing condition

A claim may be denied due to a pre-existing condition, which is expressed in your policy as a period of treatment for a medical condition before the coverage began.

4. Non-fulfillment of the elimination period

Elimination period is a time between 30 days to 6 months in which a claimant must be continuously disabled to be able to be eligible for benefits.

5. Not under the care and treatment of proper medical professional

To be recognized as a credible finding, a claimant must undergo treatment with a certified doctor or medical practitioner who can support his disability claim.

6. Self-reported symptoms exclusion

Self-reported symptoms are unacceptable reasons, which are excluded in some policies as a disabling condition. Headache, dizziness or fatigues are symptoms that are difficult to document by objective findings. Self-reported symptoms of an illness cannot be admitted as reasons in a claim unless they are stated in an official medical statement of a doctor as part of an objective medical finding.

More often than expected, many disability insurance claims are denied in the initial stage. When this happens, different reasons for its rejection play in mind.

Here are some of the common reasons why a disability insurance claim is denied:

1. Lacks objective findings

The social security reviewer who looks into your application may dismiss your claim on the grounds that it lacked the so-called "objective findings" to substantiate your disability claim. Hard medical evidence such as blood tests, MRI results, x-rays, etc. of your physical or mental condition are sometimes needed by the claims reviewer to decide on your claim. Lack of this vital information often becomes an obstacle in the approval of a claim.

However, some disability insurance policies do not require the absence of objective findings as basis for the denial of a claim. In this case, you will need the help of a disability lawyer to help you pursue your claim.

2. You are not disabled from your occupation

A claim reviewer may also deny your claim on the basis that you are not disabled as defined in your occupation. You may be experiencing stress at work, but the claim reviewer will not consider this as disability required by your occupation.

Sometimes he may even use inaccurate job description to determine your disability and use it as basis for denial. In such case, you must get an explanation from the claim reviewer and consult a disability lawyer.

3. Pre-existing condition

A claim may be denied due to a pre-existing condition, which is expressed in your policy as a period of treatment for a medical condition before the coverage began.

4. Non-fulfillment of the elimination period

Elimination period is a time between 30 days to 6 months in which a claimant must be continuously disabled to be able to be eligible for benefits.

5. Not under the care and treatment of proper medical professional

To be recognized as a credible finding, a claimant must undergo treatment with a certified doctor or medical practitioner who can support his disability claim.

6. Self-reported symptoms exclusion

Self-reported symptoms are unacceptable reasons, which are excluded in some policies as a disabling condition. Headache, dizziness or fatigues are symptoms that are difficult to document by objective findings. These of an illness cannot be admitted as reasons in a claim unless they are stated in an official medical statement of a doctor as part of an objective medical finding.