Why do LTD claims get denied? (Part 3)

Earlier in this series we talked about how missed deadlines, excluded conditions, insufficient medical evidence and not meeting the definition of “total disability” can result in a denied LTD claim. Today, we’re sharing two more common reasons that insurers reject LTD applications.

Surveillance

Insurance companies will go to great lengths to verify that you are disabled. Sometimes they may obtain surveillance video footage; other times, a simple social media search is all they need to find “proof”.

This can be distressing because most people with disabilities have good days and bad days in which they are able to do more than usual or less than usual, so surveillance may not be truly representative of the person’s abilities. This can be especially true for “invisible” injuries or illnesses (such as brain injuries or mental health disorders). One area where surveillance can be deceptive is physical activity. Oftentimes, exercise and outdoor time are actually included in treatment plants to help with depression or anxiety. Your doctor may be able to provide context to any problematic surveillance or social media content.

People often post the best parts of their life on social media, and downplay the not-so-good–social media is rarely a true representation of a person’s life. Still, when it comes to insurance, we do need to be mindful of how our online selves may be perceived.

Refusing treatment or skipping appointments

Attending all of your scheduled appointments and following your treatment plan is critical. Of course, it’s in your best interest, health-wise, to do so, but also because insurers look for every opportunity to say that you are not taking your health or recovery seriously.  Therefore, if the insurer sees that you aren’t receiving regular medical care for your impairments, or that you are not following the recommended course of treatments, they will often deny your claim.

Sometimes the insurance company wants you to undergo what’s known as an Independent Medical Exam (IME), which means an assessment by a doctor they have hired. Refusing to undergo an IME will be a strike against you by the insurer.

What next?

So, if you’ve been denied for one of these reasons, what can you do?

First of all, remember that LTD denials are extremely common, so don’t lose hope. Carefully review your denial letter and talk things over with your doctor. We also encourage you to speak with a lawyer because in many cases, applying pressure on the insurer will result in a change of decision.

At Van Dyke Law, we know the stress that comes with having your LTD denied or cut off. In this video, Frank Van Dyke explains how he helps clients in this situation. Contact us today so we can help you, too.