Even though you may pay monthly premiums for your disability insurance, there's no guarantee your insurance provider will pay your claim when you need to submit one. Unfortunately, your provider can deny you coverage, and here are three reasons it may choose to do so.
The Disability is Caused by a Pre-Existing Condition
One reason your claim for coverage may be denied is if your disability was caused by a preexisting condition; that is, a medical problem you were previously diagnosed and treated for prior to obtaining coverage from the insurance provider. For instance, you suffered a back injury from playing a sport, which inspired you to obtain disability insurance. If you become disabled because of that back injury, your provider may not pay out on your claim.
However, not all insurance providers bar claims related to preexisting conditions. In fact, many will approve these types of claims after a waiting period (e.g. within two years after the date your policy kicks in). Therefore, it's best to read your contract to determine if this is the case. Unfortunately, if your injury does land within the restricted time period, there may not be much you can do to get the denial overturned.
The Disability is the Result of an Excluded Cause
Another reason your claim may be denied is because the disability is the outcome of an excluded cause. There are certain types of source injuries insurance companies will not cover. Disabilities resulting from drug or alcohol abuse, suicide attempts, commission of criminal acts, and acts of war are some of the most common exclusions.
However, some insurance policies will also deny coverage for disabilities obtained while participating in risky activities, such as sky diving, scuba diving, and mountain climbing. Oddly enough, some providers will exclude claims for certain body parts. If you have asthma, your policy may have a special rule stating you cannot file claims for lung-related disabilities.
It can be immensely challenging getting around exclusions like these. You may be able to win some money if part of your disability can be attributed to other causes besides the ones excluded. For instance, illegal drugs like cocaine can cause heart damage. However, if you can prove the damage to your heart is partly caused (or acerbated) by a workplace accident, you may be able to get reduced benefits from your provider.
The Insurer Doesn't Believe the Doctor
A third issue that may come up is the insurance provider doesn't believe the report your doctor issues about your injuries and disability. There are a number of reasons this can happen. The insurance provider may not believe your injuries could result in the disability you're claiming (e.g. the type of back injury you have should not result in paralysis).
The company may not think the doctor you're consulting is reputable. If the doctor has a reputation for being involved in shady dealings, this may cast doubt in the insurance provider's mind about the truthfulness of his or her reports.
Still, some insurance companies will only take the word of doctors they approve of. If your doctor is not on the list of approved providers, the company may reject his or her analysis of your injuries.
The best way to overcome these types of objects is to get a second opinion from other healthcare providers. This can confirm for the insurance company that your injuries are legit and as severe as you claim. While it may be inconvenient to go through all this trouble, this may be the only way to get your claim approved.
To learn more about issues you may face getting your disability claim approved or help with your case, contact an attorney.
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