When you get your disability insurance through work, a federal law called the Employee Retirement Income Security Act (ERISA) governs what insurance companies can and cannot do. According to the law, the insurance company must provide you with a reason why they have denied your claim.
Most disability claims are denied because the insurance company believes you do not meet the policy’s definition of disabled or claims that your medical evidence is not strong enough.
Other common reasons include alleged lack of objective medical proof, missed deadlines, paperwork errors, pre-existing condition exclusions, or claims that your functional limitations do not prevent you from working. You must understand exactly why the insurance company will not pay your benefits before you can appeal their decision.
Your Claim May Be Denied if You Are Not “Disabled”
Each insurance policy contains a definition of “disabled,” and you must prove that you fall under this category to qualify for benefits. You can do this by including medical evidence and supporting documentation with your claim. When you have filed your initial claim, what you are trying to show is that your condition is such that you are unable to perform the duties of your job. This is as opposed to not being able to work at all, which is a higher standard that you will need to meet after 24 months of receiving benefits. While there may be some variation of the term with different insurance policies, the term is almost always interpreted the same way.
The insurance company may be even more difficult when your condition relies on symptoms that you have reported that cannot be backed up by objective medical evidence. For example, you could be in constant pain due to fibromyalgia. This condition is one that does not show up on blood tests or imaging.
The Insurance Company May Still Think That You Can Work
Your claim is often denied because the insurance company thinks that you can still do your own job. They may claim that you have not presented enough evidence showing your medical condition. The insurance company is notorious for having a doctor who has never seen or treated you, who thinks that they know better than your treating physician. Even if the insurance company accepts the fact that you have a medical condition, they may argue that you do not have limitations because of it. Even if the insurance company accepts your medical evidence, they may argue that it does not interfere with your ability to do your own job.
The insurance company does not get the final word when they have denied your disability claim. You have the right to file an appeal under ERISA, first with the insurance company and then in court. You are entitled to have a federal judge review your case if the insurance company does not back down first.
Contact a Houston Disability Attorney
You should not try to deal with the insurance company on your own if they have denied your disability claim. Our skilled Houston disability lawyers at Raval Trial Law can vigorously present your case throughout the appeals process, working to either overturn the denial or reach a settlement with the insurance company. Schedule an initial consultation by calling us at (713) 324-8118 or by messaging us online.
