Filing a disability insurance claim can be a daunting process, especially when your financial security is on the line. Whether you’re dealing with a Long Term disability insurance policy through work or filing a Short Term disability claim after a recent injury, the hope is that your insurer will support you when you need it most.
Unfortunately, that’s not always the case.
At Osterhout Berger Daley, we work with clients every day who have been blindsided by denied claims. This guide will walk you through the most common reasons disability insurance claims are denied, what you can do to protect yourself from the start, and how working with a qualified disability law attorney can increase your chances of success.
Denials Are Common but Often Preventable
It’s easy to assume that disability benefits are a given if you’ve paid into your plan or have a legitimate health condition. But many claimants quickly learn that insurers have strict definitions of “disability,” detailed policy exclusions, and complex paperwork requirements.
The result? A high percentage of valid claims are denied.
Insurance companies like The Hartford, Mutual of Omaha, and MetLife are known for denying claims based on insufficient documentation, vague medical records, or contractual loopholes. These are sophisticated companies with legal departments focused on minimizing payouts.
How Insurers Deny Disability Claims
Here are some of the most common reasons disability insurance companies deny claims:
1. Unclear or Incomplete Medical Evidence
If your claim lacks consistent, detailed medical documentation that clearly shows how your condition limits your ability to work, it’s likely to be denied. Insurers often say, “Your medical records don’t support disability.”
2. Failure to Meet the Policy’s Definition of Disability
Every insurance policy defines “disability” differently. Some require that you be unable to perform your own job, while others require that you can’t do any job at all. Not understanding this language is a common pitfall.
3. Missed Deadlines or Procedural Errors
Insurance companies often require claims to be filed within a certain timeframe and supported by specific documentation. Failing to follow these steps exactly—even if you qualify—can trigger a denial. Timelines vary, so it’s important to act quickly.
4. Pre-Existing Condition Exclusions
Many policies exclude conditions that existed prior to the coverage start date. If you’ve been treated for a condition within a certain period before filing, your claim could be denied even if your condition has worsened since.
5. Lack of Objective Evidence
Conditions like fibromyalgia, migraines, and mental health disorders are harder to prove with imaging or lab tests. Insurers may argue your disability is “subjective” and therefore unproven.
6. Surveillance or Social Media Activity
Some insurers conduct video surveillance or review social media to dispute a claimant’s reported limitations. Even innocent posts can be misinterpreted.
How to Protect Yourself from a Denied Claim
The good news is that many denials are preventable with the right preparation and support. Here’s what you can do:
1. Understand Your Policy Before You File
Before submitting a claim, read your disability insurance policy carefully. Look for:
- The definition of disability
- Elimination and benefit periods
- Exclusions for pre-existing conditions
- Required documentation and timelines
This is especially important for Long Term disability insurance policies through providers like MetLife or Mutual of Omaha, which can be dense and difficult to interpret.
2. Get Consistent Medical Treatment
One of the strongest forms of evidence is a well-documented medical record. Visit your doctors regularly, follow their treatment plans, and ask them to clearly note your functional limitations—not just your diagnosis.
3. Communicate Clearly With Your Doctor
Many claims are denied because providers write vague notes like “patient is doing okay” or “stable.” If you’re applying for disability, your doctor should understand what you’re applying for and how to accurately document your limitations.
Consider providing your physician with a written overview of your symptoms and daily limitations. Be honest—but specific.
4. Maintain a Symptom Journal
Keeping a daily log of your symptoms, challenges with daily tasks, pain levels, and medication side effects can provide additional context for your claim.
5. Hire a Disability Law Attorney Before You File
A disability law attorney doesn’t just help after a denial—they can help prevent one in the first place. An experienced legal team will:
- Review your policy
- Help you gather the right medical documentation
- Communicate with your provider
- Submit a complete, strategic claim package
Working with a Short Term disability attorney or a Short Term disability claim lawyer early on is especially helpful when dealing with time-sensitive benefits and aggressive insurers like The Hartford.
What to Do if You’ve Already Been Denied
If your claim has already been denied, you still have options. Most policies include the right to appeal—but time is limited. Denials should be reviewed immediately by an attorney to:
- Identify weaknesses in the initial claim
- Collect supplemental medical or vocational evidence
- Craft a persuasive appeal that aligns with the insurer’s criteria
Be aware that appealing a denial is not the same as starting over. It gives you a chance to strengthen your existing claim—and maintain your place in the review timeline.
Insurers We Commonly Work With
At OBD, we’ve helped clients appeal claims from all major insurers, including:
- Mutual of Omaha
- Principal Financial Group
- Guardian
- Northwestern Mutual
- The Standard
- MassMutual
- Lincoln Financial
We understand their internal processes, claim review tactics, and how to challenge unfair denials effectively.
Why Choose OBD?
We’ve helped clients recover more than $500 million in disability benefits across:
- Employer-provided Long Term Disability insurance
- Short Term Disability benefits
- Private and Individual Disability policies
- Social Security Disability (SSDI)
- Veteran Affairs Disability (VA)
We know what it takes to build a successful claim and protect you from wrongful denial.
Get Help Before It’s Too Late
Don’t wait until your claim is denied to get legal help. Whether you’re about to file a claim or you’ve already received a denial letter, we’re here to guide you through it.
Call 412-794-8003 or 1-866-438-8773, or fill out our secure intake form to schedule your free consultation.
Note: This article is for informational purposes only and does not constitute legal advice. Timelines and requirements vary by policy and jurisdiction. Always consult with an attorney about your specific case.