The higher body governing the screening of all long-term disability (LTD) claims is the federal law known as ERISA, or the Employee Retirement Income Security Act. Under the ERISA, claims administrators working with insurance companies are put in charge of evaluating LTD applications, who have the final say on whether they’ll let an application pass through. There are various reasons for a claim to be axed, with some of the most common as follows:
Clerical/Procedural Errors – LTD claims require quite an amount of documentation for them to be considered. If all mandated papers aren’t sent to the insurance adjuster promptly, the typical result is a denial.
Insufficient Medical Evidence – Whether it’s the failure to seek treatment, missing medical records or a personal, detailed opinion from a physician, it doesn’t matter: any inadequacy of any form with regards to proving disability is enough reason for a denial.
Pre-Existing Medical Conditions – Any claimant with a specific medical condition present prior to being insured is at risk of getting written off by the adjuster, though such a ruling rarely applies to a group policy insurance through the employer.
Failure To Satisfy Criteria For Disability – Adjusters typically possess a set definition of disability, which may vary across different companies. It’s important to check a policy’s summary plan description beforehand for such a definition, and gauge if the criteria can be met. For instance, an “own occupation” LTD policy considers one disabled if he or she is medically unable to fulfill a particular occupation’s duties.