Why So Many Long-Term Disability Claims Get Denied and What You Can Do

Long-term disability insurance exists to protect workers when illness or injury prevents them from earning a living. Yet despite paying premiums for years, many claimants face the frustrating reality of a denial of their long-term disability claim. Understanding why insurers reject long-term disability claims and how to strengthen your application can make the difference between financial security and devastating hardship.

Insurance companies deny a significant percentage of initial long-term disability claims, with some estimates suggesting denial rates between 40-60 percent (with private-ERISA type plans coming in at 32.5% initial denial rates). While these companies market their policies as safety nets, their primary obligation is to shareholders, not policyholders. This fundamental conflict of interest shapes how claims are evaluated and why so many legitimate applicants receive rejection letters.

Common Reasons for a Long-Term Disability Claim Denial

Insurance companies can rely on various grounds to deny a long-term disability benefits claim. Below are some of the most common reasons cited by insurance companies to reject a long-term disability claim:

• Insufficient Medical Evidence: The most frequent reason for denial is inadequate medical documentation. Insurers require objective evidence that your condition prevents you from performing your job duties. A diagnosis alone isn’t enough. They want detailed medical records showing the severity of your symptoms, how your condition affects your daily functioning, and why you cannot work. Many applicants assume their doctor’s statement that they’re disabled will suffice. Unfortunately, insurers scrutinize every detail. If your medical records show gaps in treatment, inconsistent symptom reporting, or lack specific functional limitations, they’ll use these weaknesses to justify denial.
• Pre-existing Condition Policy Exclusions: Many LTD insurance policies include pre-existing condition clauses that may exclude coverage for conditions you had before your policy took effect or during a specific lookback period. Insurers aggressively apply these exclusions, sometimes arguing that current symptoms relate to previous health issues, even when the connection seems tenuous. They may comb through years of medical history searching for any prior mention of related symptoms.
• Missing Deadlines: Long-term disability policies impose strict deadlines for filing claims and submitting documentation. Missing these deadlines by even a day can result in automatic denial. The claims process often requires submitting initial applications, attending independent medical examinations, providing updated records, and filing appeals—all within specific timeframes. One missed deadline can derail an otherwise valid long-term disability claim.
• Surveillance and Social Media: Insurance companies frequently hire investigators to surveil claimants or monitor their social media accounts. A video of you carrying groceries, playing with your children, or attending a social event can be taken out of context and used as evidence that you’re not truly disabled. Even innocent posts about a “good day” can be twisted to suggest you’re exaggerating your limitations.
• Vocational Assessments: Some denials stem from vocational evaluations where insurers argue you can perform sedentary or alternative work, even if you cannot do your own job. Policies that define disability as inability to perform “any occupation” rather than “your own occupation” make it easier for insurers to deny claims by identifying theoretical jobs you might perform, regardless of whether those positions actually exist in the job market or match your qualifications.

How to Improve Your Chances of Approval of Your Long-Term Disability Claim

There are proactive steps you can take to help improve the odds of your long-term disability claim getting approved. Those steps include:

• Build Strong Medical Documentation: Ensure your medical records properly document your condition. Be specific with your doctors about how symptoms affect your ability to work. Don’t downplay your limitations or put on a brave face during appointments. Your medical records should clearly describe your pain levels, fatigue, cognitive difficulties, and physical restrictions. Request that your treating physicians provide detailed narratives explaining your functional limitations. Generic form letters rarely suffice. Ask them to address specific job requirements and explain precisely why you cannot meet those demands. Objective test results, specialist consultations, and consistent treatment records can help strengthen your LTD benefits claim significantly.
• Understand Your Policy Thoroughly: Read your policy document carefully to understand the definition of disability, elimination periods, benefit periods, and exclusions. Know whether your policy covers “own occupation” or “any occupation” disability. Understanding these terms helps you frame your claim appropriately and avoid triggering exclusions.
• Submit a Complete Application: When filing your claim, include everything the insurer requests and more. Provide comprehensive medical records, detailed statements about how your condition affects your work, and supporting documentation from family members or colleagues who’ve observed your limitations. Incomplete applications invite denial.
• Meet Deadlines: Create a calendar tracking every deadline associated with your claim. Submit materials well in advance to account for mail delays or processing issues. If you need an extension, request it in writing before the deadline passes.
• Be Consistent in Your Statements: Ensure consistency across all your statements to doctors, insurers, and investigators. Inconsistencies become ammunition for denial. If you tell your doctor you can’t sit for more than 20 minutes, don’t tell the insurance company you can sit for an hour. Keep a symptom diary to maintain accurate records of your limitations.
• Be Cautious with Social Media: Consider making your social media accounts private and be mindful of what you post. Even well-meaning friends tagging you in photos can create problems. Avoid posting anything that could be misinterpreted as evidence of physical capability beyond your claimed limitations.

If Your Long-Term Disability Claim Was Denied, Speak to an Attorney and File an Appeal

If your LTD benefits claim is denied, don’t give up. It is possible to get a long-term disability claim denial overturned on appeal. Review the denial letter carefully to understand the insurer’s reasoning, gather additional evidence addressing their concerns, and submit a comprehensive appeal within the deadline. This is often where retraining the services of an experienced LTD benefits attorney can pay dividends.

Appealing an LTD denial can be challenging, particularly if you aren’t familiar with the technical rules that apply to these matters. At Bross & Frankel, we will work with you to help you understand your rights and your options for pursuing an appeal. If you decide to appeal, we will fight to get you the benefits that you deserve.

Have Questions? Speak to an LTD Benefits Lawyer Today

It’s an unfortunate reality – insurance companies often deny legitimate long-term disability claims and are known to make the claims process difficult for individuals. This is why it makes sense to contact an experienced and knowledgeable LTD benefits lawyer to discuss your legal options.

A long-term disability attorney with Bross & Frankel can help ensure you get the disability benefits you are entitled to under the terms of your policy. We will evaluate your LTD insurance policy, analyze relevant medical records and other supporting documentation, and suggest additional ways to strengthen your long-term disability claim. If the insurance company tries to delay or deny your LTD benefits claim, we will push back to protect your rights. To learn more or to schedule a free claim review with a New Jersey long-term disability attorney, give us a call at 856-795-8880 or fill out our online contact form.