Disability insurance may be your only source of income if you can no longer work. However, some insurance companies will deny your disability claim even if it is valid. Social Security and veterans’ benefits claims can also be wrongfully denied. With legal help, you may be able to overturn the denial and receive compensation.
What Is Disability Insurance Denial?
Disability insurance provides income to those who can no longer work due to an illness or injury. It can cover either short-term or long-term leaves of absence.
Disability insurance can help pay for:
- Car payments
- Food and groceries
- Medical expenses
- Rent or mortgage
- Other bills, such as utilities
You usually need to file a disability claim through your insurance company to receive these benefits. In some cases, you can also receive benefits from the Social Security Administration (SSA) and the Department of Veterans Affairs (VA).
Unfortunately, not all claims are successful. When you are denied disability insurance, the company or agency in question has deemed that you cannot receive benefits — even if you may actually qualify.
There are ways to reverse this decision by filing an appeal. An appeal is a request that asks for your claim to be reconsidered. However, companies and government agencies complicate the appeals process to the point where you may want to give up.
Working with a lawyer may help make the appeals process easier. If you have been previously denied, they know the systems and processes that may help you succeed in receiving benefits. Sokolove Law may be able to help you appeal your claim and receive compensation.
How Disability Can Be Denied
To receive disability benefits, you need to file a claim with an insurance company or a government agency. While the claims process varies between companies and agencies, most processes are very complicated.
Most claims are lengthy documents that require you to prove how you were injured and why you can no longer work. Claims can be very tricky because even a single mistake can cause your claim to be denied.
In some cases, your claim can also be rejected or delayed for long periods of time even if you did everything correctly. In turn, companies are able to keep the money they owe you for themselves.
Below you will learn how different disability claims can be denied — and what you can do to fight back.
Long-Term Disability Denial
Long-term disability insurance is essential for those in high-risk jobs. It ensures that, if you are injured or sick and can no longer work, you can still receive income.
While long-term disability insurance can be very helpful, some companies deny long-term disability plans if they do not believe you qualify. They will review your claim and outline the reasons why you will not receive compensation.
In some cases, you may have qualified, but the company may be actively working against you so they do not have to pay.
To reduce their chances of having to pay, companies make the claims system very complex.
A complex claim system causes:
- Frustration: If it is hard to file a claim, people will be less likely to do so even if they can receive compensation.
- Mistakes: By making the claims process confusing, it increases the odds of mistakes. An error from either an applicant or an employee of the insurance company can cause a claim to be denied.
When insurance companies actively work against applicants, they are acting in bad faith.
Bad Faith Insurance Denial
Bad faith insurance denial occurs when a company refuses to compensate you for an insurance claim. These companies use lies and confusion to make it very hard for you to get anything from them.
When you first started paying for insurance, you entered a contract with your insurance company. By paying monthly premiums to them, you thought you would receive compensation if you got seriously hurt or sick later on.
For most insurance companies, it is actually better for them to not approve your long-term disability claim. At the end of the day, insurance companies are businesses that need to make money. Paying every claim simply is not in their best interest.
Some insurance companies prioritize profits over customers. By paying out as few claims as possible, they keep profits high for their shareholders and executives.
Insurance companies can act in bad faith by:
- Denying your claim
- Delaying your claim for long periods of time
- Not paying out your claim in full
- Confusing policyholders with obscure clauses and lengthy claims processes
- Wrongfully canceling your policy
- Giving bonuses to employees who deny claims
Insurance companies that act in bad faith are not keeping their end of the deal.
Social Security Disability Denial
Outside of a private insurance company, you can receive benefits by applying for Social Security Disability Insurance (SSDI). However, your claim can still be denied even if you qualify for benefits.
According to recent data, over 60% of all SSDI claims are rejected at first by the Social Security Administration (SSA).
Unlike an insurance company, the SSA will not act in bad faith. The main reason SSDI claims are denied is that the claim is filed improperly.
With your claim, you have to prove why you need SSDI. Filing an SSDI claim requires information about yourself, your work history, and your illness.
To file your SSDI claim, you may need:
- Records of all hospital visits related to your condition
- Names of doctors, clinics, and hospitals
- Dates of treatment and medical tests
- Current medications and who prescribed them
- Patient ID numbers
- Medical evidence related to your condition
- Test results proving you have the illness or injury
- Documents proving how your condition affects your ability to work
- Any previous, current, and/or future benefit plans you filed or will file
- Documentation or proof of these benefits
Of course, most people do not have this information easily accessible. Without some assistance, gathering all of the needed information can be very challenging — especially if you are dealing with an illness or injury that requires intensive medical care.
On top of that, it can take 3-5 months for the SSA to process your claim. If your claim is denied or delayed, it can take months (or even years) to receive SSDI benefits.
Veterans Disability Denial
Veterans can apply for VA disability benefits if they have an illness or injury related to their service. This includes conditions such as post-traumatic stress disorder (PTSD), hearing loss, or cancer.
However, like Social Security, filing a VA claim can be very difficult. As of 2019, it takes over 3 and a half months for the VA to make a decision on a claim. This process can be even longer if a veteran’s claim is denied or delayed.
To prevent this, veterans need to file their claims accurately and provide key supporting documents.
A veteran’s claim must:
- Show that they have a long-term disability
- Prove how their service caused or worsened their condition
- Provide medical documents that link their service to their disability
However, even if a veteran has all of this information, it still can be hard to organize it in a way that shows why they need disability benefits. A simple mistake may cause a claim to be delayed or rejected.
The VA is aware that veterans may experience difficulties with their claims. The agency recommends that veterans work with a claims agent, Veterans Service Officer (VSO), or attorney to help file their claims.
These accredited agents can help veterans file their claims in a way that best proves why they need disability benefits. They can also help file an appeal if a claim was previously denied.
How To Appeal a Disability Claim Denial
If your claim was denied, you may be able to appeal this decision. However, appealing a denial can be a lengthy and complicated process.
While the process varies with each type of insurance, in most cases, you will need to file an additional claim explaining why your original claim should not be denied. You may also need to provide additional evidence or documents to support this new claim.
Simply filing an appeal does not guarantee you will receive compensation. In fact, filing an appeal could just be the first step in a longer process.
If your appeal is rejected, you can still get it overturned. To do this, you must take your case into the court system. However, this can be very overwhelming and time-consuming if you are not well-versed in the legal process. You may need to fill out lengthy legal documents, schedule hearings with judges, and, in some cases, appear in court.
Fortunately, working with a lawyer can make the process much easier. A lawyer can help strengthen your appeal, represent your interests in court, and work to pursue the most compensation possible on your behalf.
Legal Help for Disability Denial
Lawyers often make the difference between receiving compensation and losing out completely. Disability denial lawyers understand the claims and appeal systems. In turn, they may help you reduce your chances of errors and have a better shot at compensation.
Disability denial lawyers can help:
- Build Your Case: Lawyers will help you fill out confusing legal documents. They will also work with you to gather important documents to strengthen your case.
- File Your Appeal: By trusting your lawyer to file your appeal, you can rest easy knowing it was filed correctly. Your lawyer will know how, when, and where to properly file your appeal.
- Represent You In Court: If your case reaches a trial or hearing, you will need good representation. Insurance companies often employ top lawyers to represent their interests, and they will do anything they can to prevent you from receiving compensation. Government hearings can also be challenging, as you and your lawyer will need to prove before high-ranking officials why you qualify for disability insurance.
Sokolove Law and Disability Insurance Denial
General lawyers may not have the resources needed to truly make your case successful. On the other hand, Sokolove Law has lawyers on staff who can help you through the appeals process if your claim was denied. We have licensed attorneys in almost every state and VA-accredited attorneys on staff to assist veterans.
If your insurance claim was denied by an insurance company, the SSA, or the VA, we may be able to help you. It costs nothing to speak with our case managers, and our lawyers will not get paid unless you receive compensation.