Disability Claim Denial Cases: Helping You Appeal Your Disability Claim

Disability insurance provides financial support to individuals unable to work due to a physical or mental condition. However, in some cases, the insurance company may deny a disability claim. If the disability insurance claim you filed did not get paid by the insurance company, it’s essential to understand why and know your rights as a policyholder. This article will discuss the types of disability programs in Florida, common reasons for disability insurance claim denial, steps you can take to appeal a denied claim, and ways to prevent claim denial in the first place.

Programs Available in Florida

Florida does not have a state-wide disability program (only five states in the U.S. do); however, there are several programs most people qualify for. Social Security Disability Insurance (SSDI)- This program supports Americans who cannot work due to their medical condition. The Social Security Administration (SSA) is the agency that administers the program. You qualify if you have worked and paid taxes, and the benefit your receive is largely dependent on how much you historically have paid into the program. In most cases, if you have worked 5 out of the last ten years, then you qualify for SSDI. Supplemental Security Income (SSI)- If your work history does not meet the threshold or you have not worked enough recently to qualify for SSDI, you may qualify for SSI. SSI is also a federal program, is only for individuals with little income and assets, and the application is the same. Veterans Disability benefits- As the name implies, this program is for those who served in the military and suffered injuries preventing them from working or as a retiree with a medical condition resulting from their service. To be considered for benefits, you must apply through the Department of Veterans Affairs. Long-term/Short-term private disability insurance: If you purchased disability insurance on your own or through your employer and became disabled after purchasing coverage, you should be able to file with your insurance company. Most policies will pay out a percentage of your prior pay over a specific number of months, but how much you will receive will depend on the policy you purchased. To qualify for SSDI, you must be under 67 years old, have a disability that will last more than one year or potentially lead to death and meet the “work credits” requirements for your age. For SSI, you must also have a disability that will last more than one year or potentially lead to death, have few assets, and have very little or no income.

Common Reasons for Disability Insurance Claim Denial

One of the most common reasons for disability insurance claim denial is that the policyholder did not meet their policy requirements. For example, if your policy requires you to report a disability within a specific timeframe and fails to do so, your claim may be denied. Additionally, your claim may not be approved if your policy has exclusions or limitations that apply to your claim, such as pre-existing conditions. Another common reason for disability insurance claim denial is that the insurance company believes the policyholder is not disabled to the extent they are claiming. Your claim denial could be because you, the insured, have not provided enough medical documentation to support their claim or because the insurance company believes the policyholder exaggerates their disability. Finally, some insurance companies may deny claims simply because they are trying to save money. The basis for saving money is particularly true in cases where the policyholder has a history of making claims or where the disability for the insured may be long-term.

Preventing Claim Denial

The best way to prevent disability insurance claim denial is to ensure that you understand your policy’s terms and meet all requirements. The requirements included reporting disabilities promptly, providing complete and accurate documentation when making a claim, and avoiding exaggerating the extent of your disability. Additionally, it’s essential to keep detailed records of your policy, including the policy number, the date it was issued, and any changes made over time. It’s also a good idea to review your policy annually to ensure that it still meets your needs and to check for any exclusions or limitations that may apply to your claim. It is also essential to be aware of the timelines and procedures of your policy. It is a common issue that claims deemed denied are due to missing a deadline to file a claim or not following the procedures outlined in the policy. In summary, disability insurance claim denial can be a frustrating and confusing experience for policyholders. It’s important to understand the reasons for the denial, know your rights, and take the appropriate steps to appeal the decision. By understanding your policy, reporting disabilities promptly, providing accurate documentation, and seeking the help of a lawyer, when necessary, you can help ensure that your claim is approved.

Steps to Appeal a Denied Claim

If your disability insurance claim is not approved, you can appeal the decision. The first step in the appeal process is to request a written explanation of the reasons for the denial from your insurance company. Once you have this explanation, you can gather additional documentation or evidence supporting your claim. Next, you’ll want to write a letter to your insurance company outlining why you believe your claim should be approved. Include any additional documentation or evidence you’ve gathered in your letter, including medical records, statements from your treating physician, and other relevant information. Finally, you can also seek the help of a lawyer who specializes in disability insurance claims to help you navigate the appeal process. An attorney can review your policy, help gather the necessary documentation, and represent you in an appeal hearing. Attorney Don McKeever has over 35 years of experience to help you with your claim. Call 407 628-4878.