Why would long-term disability be denied?

Asked by: Shaina Kovacek III  |  Last update: July 1, 2025
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Missing or insufficient medical evidence: Long-term disability claims often get denied if they lack sufficient information to justify an approval, like medical records and medical statements from your doctor.

Why is it so hard to get long-term disability?

Disability insurance carriers have a financial incentive to deny claims whenever they can, so seeing that you're seeking medical treatment only intermittently may help the insurer argue one of two things: (1) your disability isn't that serious (or you'd be seeing the doctor more often); or (2) you're exacerbating your ...

Why would a long-term disability claim be denied?

Insufficient Medical Evidence

A lack of sufficient medical evidence is one of the most common reasons disability insurance claims are denied. Insurers often require objective test results, such as x-rays, MRIs, electrodiagnostic tests, lab findings, or psychological testing, to support a disability claim.

What not to say in a long-term disability interview?

Exaggerating the extent of your disability will not improve the odds that your application is approved. In fact, claimants who complain of chronic pain that is untreatable might make a poor impression on the ALJ. Inflated claims of pain are never a good idea during a disability hearing.

What are the requirements for long-term disability?

We consider your medical conditions, age, education, past work experience, and any transferable skills you may have. If you can't do other work, we'll decide you are eligible for disability benefits. If you can do other work, we'll decide that you don't have a qualifying disability and your claim will be denied.

Can My Long Term Disability Claim Be Denied for a Pre Existing Condition?

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What are the most approved disabilities?

Overall, however, the most approved disability for Social Security is disabilities involving the musculoskeletal system and/or connective tissues. According to the World Health Organization (WHO), such conditions include arthritis, back pain, and lupus.

What are the cons of long-term disability?

Cons:
  • Disability insurance can be expensive. Coverage costs more the older you get or the more dangerous your job is. ...
  • Policies can come with exclusions that don't cover pre-existing conditions. ...
  • Waiting period. ...
  • If you never experience a disability, you won't receive benefits.

What illness automatically qualifies for disability?

It includes:
  • Musculoskeletal Disorders, such as arthritis, fibromyalgia, and back pain.
  • Special Senses and Speech, such as blindness and hearing loss.
  • Respiratory Disorders, such as cystic fibrosis and respiratory failure.
  • Cardiovascular System, such as hypertension and heart disease.

Can I lose my job while on long term disability?

It's rare, but it is possible. In many cases, a disabled individual will continue to be given long term disability benefits if they are employed or not. If you find yourself in this dire situation, you can still file for long term disability benefits with the help of a California lawyer.

What not to tell a disability judge?

Subjects to avoid unless you are directly questioned include:
  • Any family members receiving unemployment or disability benefits.
  • Details about your criminal history.
  • Issues related to alcohol or drugs.
  • Non-compliance with your doctor's orders.
  • Living in a town with no available job opportunities.

Why do most people get denied for disability?

The most common nonmedical reason for denying a claim is insufficient number of recent work credits.

How do you win a long term disability appeal?

Five Ways to Win Your Long Term Disability Appeal
  1. Meet the Deadline to Appeal Your Long Term Disability Denial under ERISA.
  2. Request a Copy of Your Disability Claim File.
  3. Get Your Doctor Involved.
  4. Get Your Own Experts. The Functional Capacity Evaluation. ...
  5. Address Every Reason for the Denial.
  6. Conclusion.

Does long term disability ever end?

The duration of benefits will depend on the long-term disability policy. These vary widely, however they're usually anywhere from one to 10 years. Some benefits will last until retirement or until the employee is 70 years old.

Why was my long term disability denied?

Missing or insufficient medical evidence: Long-term disability claims often get denied if they lack sufficient information to justify an approval, like medical records and medical statements from your doctor.

What is the easiest condition to get disability?

What Is the Most Approved Disability? Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. This is because arthritis is so common. In the United States, over 58 million people suffer from arthritis.

What do I say to get long term disability?

To receive disability benefits, you will have to show that you cannot work in your profession and continue to earn a living. Your physician will need to provide a detailed diagnosis of your condition along with a prognosis as to how your condition will prevent you from working in the future.

What qualifies you for long-term disability?

Long-term disability isn't a specific diagnosis. It refers to a condition that prevents someone from performing their work duties for a year or more. This can be due to a variety of reasons, ranging from physical injuries to mental health issues.

How long can an employee be on long-term disability before termination?

Can Your Employer Terminate You While on LTD Benefits? Unfortunately, long-term disability benefits do not come with job protection. However, if you are receiving “Family and Medical Leave” (FMLA) benefits, you do have job protection for the period in which you receive such benefits, typically up to 12 weeks.

What reduces long term disability payments?

Other kinds of income that usually reduce your long term disability benefits include Social Security retirement benefits, other federal or state disability benefits, workers' compensation, Veterans Administration benefits, retirement plan benefits funded by the employer (not tax-deferred individual retirement savings), ...

What disqualifies you from receiving disability?

These can include income levels, the severity and duration of your condition, and the degree you cooperate with medical professionals and the SSA. It is not an exhaustive list, however. Other disqualifiers can also include imprisonment and fraudulent activity.

What gives 100% disability?

The 100 percent disability rating is often awarded to veterans with two or more limbs that have been amputated or paralyzed or for veterans with active service-related diseases such as cancer, severe cardiac conditions, or psychiatric conditions such as PTSD, bipolar, depression, or schizophrenia.

Which conditions do not count as a disability?

If you struggle with the use of alcohol, nicotine or any other drug, you usually won't be considered disabled under the Equality Act.

Is long term disability hard to get?

The process of building the claim and then fighting the insurance company to approve it takes patience, dedication, and skill. Disability insurance companies care about profit, not your well-being, and they will not hesitate to deny claims that lack the required documentation and medical evidence.

What is the most common cause of long term disability?

Musculoskeletal disorders like arthritis and back pain are the leading cause of long-term disability claims, according to the Council for Disability Awareness (CDA).

How much does long-term disability cost?

One rule of thumb: expect to pay between 1 to 3 percent of your annual salary. Premiums – the amount you (or your employer) pay for the policy – can range from $25 to $500, again depending on many factors particular to your situation.