Why a Disability Insurance Claim Can Be Denied

November 11 ,2011 by admin

As much as we hate to admit it, many disability insurance claims are rejected during the initial stage of filing. There could be any of several reasons that substantiate the rejection. Here are some of the common reasons why your claim could be denied.

No objective findings

The one responsible for reviewing disability insurance claims may dismiss a claim application on the grounds that it lacks ‘objective findings’ to validate the claim. Tangible medical evidence such as MRI results, blood tests, x-rays etc of your mental and/ or physical condition could be required sometimes by the claims reviewer to substantiate a claim. Thus, lack of this important information can be an obstacle for your claim to be approved. There are however some policies that wouldn’t need the lack of objective findings to form the basis of a claim rejection. It is during such times that you will find the services of a disability insurance lawyer very handy and helpful as you pursue your claim.

Self-reported signs and symptoms

Symptoms that you report as the claimant are unacceptable and will always be excluded in most policies. Dizziness, headache, fatigues are all symptoms that are hard to document by tangible findings. Unless self-reported symptoms are confirmed and clearly indicated in an official medical statement of a certified doctor as part of a valid medical finding, they cannot be recognized as valid reasons in a claim.


An existing condition

Your claim could also be denied because of a pre-existing situation that is expressed clearly in your policy as duration of treatment for an existing medical condition before coverage commences.


You are not fully disabled from work

The person reviewing the claim can also reject your claim on the basis that you aren’t fully unable to work as defined by your job description or occupation. Perhaps you are undergoing stress at work and want to file for a claim, this may not be considered as a valid reason for filing a claim as it may not be a disability needed by your occupation. At times a claim reviewer may rely on imprecise job description to establish your disability and use it to substantiate the rejection. In such a case, consult your disability attorney on the best course of action.


Not fulfilling the elimination period

The elimination period is the duration between one and six months where you must be disabled continuously so as to be eligible for the benefits.

Find more information about short term disability insurance and how it works.