As we near the end of Disability Awareness Month, it’s important to continue shining a light on the many frustrating aspects of living with a disability – ignorant stereotypes, discrimination at work, and of course, dealing with insurance.
No matter if your insurance is for a long-term disability or something short-term like pregnancy, it can be scary to have a claim denied when you rely on that money. Due to rising costs of living expenses, fewer working Americans have enough money saved up for a medical emergency. The goal of disability insurance is to cover life expenses since your disability is preventing you from working, so a claim denial can be financially devastating. Income loss, specifically due to medical-related costs, is cited as one of the most common contributors to bankruptcy.
Disability Insurance
While work-related injuries and illnesses are covered by workers’ compensation, those situations are not the majority. In 2019, less than 1% of Americans missed work due to a work injury or illness. Disability insurance exists to cover those whose injury or illness was not caused by their occupation. There are a few different ways to get disability insurance, so the type of claim you filed will determine your next step if you’re dealing with a denial.
Social Security Disability Insurance (SSDI) is a federal disability insurance program. This system is run by the Social Security Administration, and covers people who are completely disabled and physically unable to work because of it. It is difficult to get SSDI approved, so there are many potential reasons for a claim denial.
Other types of disability insurance can be purchased privately, are provided by an employer, or are part of a retirement plan.
Disability Claim Denials
According to the disability insurance attorneys at Dawson & Rosenthal, P.C., some of the most common reasons they see for denials are as follows.
- Lack of medical evidence. One of the most important factors in getting a claim approved is proving that you have a disability that prevents your from working.
- Not following the doctor’s orders. This could include not taking your prescribed medication, not following through with physical or mental therapy, or anything else that your doctor recommended for your disability that you failed to do.
- A history of denials. If you have at least one prior claim denial on record, it could negatively impact future claims.
- The disability does not meet the criteria. Disability programs have a variety of different restrictions, for example proving that your disability will last at least 1 year.
- Your situation involves crime, drugs, or alcohol. If you sustained your disability while committing a felony, for example, you would not be covered by insurance. When it comes to drugs and alcohol there are some cases that still qualify, like if your impairment resulted from past drug or alcohol abuse. However if you are continuing to abuse drugs or alcohol and that is the cause of your disability, you won’t be covered.
If your disability claim gets denied, you can still take action to appeal the decision. In fact about two thirds of disability claims get denied on the first try, according to the Social Security Administration. Depending on your insurance program, there is usually a time limit on how long after your denial you can appeal. So make sure to file your appeal as soon as possible and follow all procedures in order to have your best chance at approval.