Why Do Insurance Companies Deny Legitimate Long-Term Disability Claims?

Apr.28.2025
Blog

Imagine this: you’ve spent years working hard, only to suffer an illness or injury that prevents you from continuing your career. You follow all the required steps to apply for long-term disability (LTD) benefits, believing you are covered, only to receive a denial letter in the mail. The shock, frustration, and fear are overwhelming.

Denied long-term disability coverage can leave you feeling hopeless, but you’re not alone. Unfortunately, insurance companies routinely deny legitimate claims, often for reasons that may seem unfair or misleading. Understanding why insurers reject claims can help you fight back and secure a different outcome.

In this blog post, we’ll explain the common reasons for denied long-term disability insurance coverage and discuss how a qualified legal professional can help you seek the benefits you deserve.

Why Do Insurers Deny Legitimate Disability Claims?

Insurance companies are businesses that exist to make a profit. They collect payments from people who buy insurance, but they lose money every time they approve a claim. This can create a conflict of interest since the people who review claims often work for the insurance company. While insurers deny some claims for fair reasons, others get rejected simply because the company wants to pay as little as possible.

Common Reasons for Being Denied Long-Term Disability Insurance Coverage

If you’ve received a denial, it’s essential to understand its reason. Some claims are denied due to technicalities, while others are rejected based on weak or misleading justifications. Below are some of the most common reasons insurers deny long-term disability claims.

Failure to Meet the Policy’s Definition of Disability

Every LTD policy has a specific definition of “disability.” Some policies define it as the inability to perform your current job, while others require you to be unable to work in any occupation. If the insurer claims you can still perform some form of work—even if it’s unrealistic given your condition—they may deny your claim.

Lack of Medical Evidence

Even if you suffer from a debilitating condition, an insurance company may deny your claim if they believe there isn’t enough medical proof. Insurers often argue that medical records do not support the severity of your disability. Providing detailed documentation from doctors, specialists, and any diagnostic tests that support your claim is crucial.

Application Errors

Insurance companies look for any mistake that can justify a denial. Errors in your application, missing paperwork, or incomplete responses can result in a rejection. Even minor omissions can be used against you, making it essential to carefully review your submission before filing.

Condition Not Covered by the Policy

Some LTD policies exclude certain conditions, such as pre-existing conditions, self-inflicted injuries, injuries related to criminal activity, or disabilities caused by substance abuse. If your condition falls into an excluded category, your claim may be denied, even if you were unaware of the exclusion when purchasing the policy.

Not Following Treatment Plan

Insurance companies expect you to follow your doctor’s prescribed treatment plan. Failing to attend medical appointments, skip therapy sessions, or refuse recommended care allows the insurer to argue that you are not taking appropriate steps to recover and deny your claim.

Dispute by Independent Medical Examiner

Many insurance companies require claimants to undergo an evaluation by an independent medical examiner (IME). However, insurance companies often hire these doctors, who may downplay your condition’s severity. If the IME’s report contradicts your treating physician’s assessment, the insurer may use it as a reason to deny your claim.

Social Media Investigations

Insurance companies often monitor claimants’ social media accounts to find evidence contradicting their disability claims. If you post pictures or updates that suggest you are more active than your medical condition implies, the insurer may use this as grounds to deny your claim, even if they take the posts out of context.

Can I Appeal a Long-Term Disability Claim?

Yes. If your employer-sponsored disability insurance claim is denied, you have the right to appeal under the Employee Retirement Income Security Act (ERISA). Challenging denied long-term disability coverage begins by going through the insurer’s internal appeals procedure. This process often involves submitting additional medical evidence, undergoing further evaluations, and responding to the insurance company’s reasoning for denial.

Be aware: Long-term disability appeals are subject to strict deadlines under ERISA. If you miss the initial filing deadline or fail to submit additional requested information on time, your claim may be automatically denied.

Appealing an LTD denial can be challenging. Insurers may use complex legal language to justify their decision, making it difficult for claimants to understand their options. Additionally, insurance companies sometimes delay appeals, hoping claimants will give up. This is where an experienced ERISA lawyer can make a significant difference.

How an ERISA Attorney Can Help

Navigating an LTD appeal requires a deep understanding of ERISA regulations and insurance company tactics. An ERISA attorney can help you by:

Reviewing your denial letter and identifying weak points in the insurer’s reasoning,
Gathering additional medical evidence and expert testimony to strengthen your case,
Ensuring all paperwork is completed accurately and on time,
Communicating with the insurance company on your behalf to prevent further delays, and
Preparing for litigation if the insurer refuses to approve a valid claim.

Ultimately, seeking legal representation can increase your chances of overturning a denial and securing the benefits you deserve.

Don’t Let a Denial Stop You—Get Legal Help Today

Receiving a denial for long-term disability benefits can be devastating, but it’s not the end of the road. The Peace Law Firm has decades of experience fighting for South Carolina workers who have been wrongfully denied the benefits they deserve. Our team understands the complexities of ERISA law and will work tirelessly to appeal your claim and protect your rights.

Don’t face the insurance company alone. If an insurer denied your long-term disability claim, contact the Peace Law Firm today for a free, no-obligation consultation. Let us help you fight back and secure the benefits you need to move forward with your life.