5 Common Reasons Insurers Deny Disability Claims

5 Common Reasons Insurers Deny Disability Claims


At Tamming Law, over our 30 years of litigating long-term disability claims, we have heard all the reasons insurers use to deny  claims for disability benefits. In our experience, there are 5 that are quite common. Let’s go over them.


#1 “Our Medical Consultant Doesn’t Think You Are Disabled”

An insurer may ask a person to review your file and to provide an opinion. This “medical consultant” (often not a doctor at all!) has not met you, has not seen half of your medical records, has not spoken to your co-workers, etc. But the insurer would have us believe that he or she is able to evaluate your disability from 20,000 feet. Obviously, this isn’t fair to you. Your LTD claim should be assessed in full, taking into account all of its impacts on your life, whether they be psychological, or physical in nature.


#2 You Don’t have enough Medical Documentation

No one knows you better than your family doctor. So in terms of documentation, nothing comes close to her file of your medical records for use in painting a complete picture of your condition, past and present. If the insurer has all of your family doctor’s records, it will also have all of your specialist records and a long history of letters to your employer and notes confirming your efforts to improve. The minute we are retained, we get that entire file and make sure the paper within it starts to work for you.


#3 You Are Not “Totally Disabled”

Look, this phrase does not mean what many think it means. It just doesn’t. You don’t need to be on permanent bedrest or unable to go out for dinner or unable to pull some weeds from your garden for an hour to meet the definition of “totally disabled”. The term “totally disabled” means that you cannot function as a reliable employee at your past job. After two years, it means that you cannot work at any comparable job for which you are reasonably otherwise suited.

It’s that simple.

#4 You Can Do Similar Work

Many people come to us when their benefits are cut-off at the two year mark. The insurer may have conducted some test (a skills evaluation of sorts) and concluded that since you can do some basic tasks, you are not disabled. But these tests are often next to useless when it comes to showing a picture of what you really are capable of on a day to day basis.


#5 We Have Videotape on You

It upsets people to be videotaped without their knowing. When an insurer says to a claimant that they have a video recording of them, many people panic. The fact is that, unless the recording flatly contradicts what you said you could do, the video often does not mean that much. It almost never decides a case.


If you, a loved one or a friend is struggling with a long-term disability claim, we are here to help. Whether the insurer has denied the claim based on one, or a combination of the reasons above, or another reason entirely, our team has the experience and tenacity to press the insurer to reinstate benefits so that you can focus on what matters: your healing.