It's Different: What You Need To Know About Private Disability Insurance Denials

20 September 2017
 Categories: Law, Blog


Having private disability insurance offers peace of mind, or at least it's supposed to. If you file a claim and are denied, that peace of mind can quickly slip away. However, one denial is not the end of the process. Admittedly, private insurance is a lot different than SSDI or employer-provided insurance, but you still may have some leeway.

You May Have an Appeal -- or Not

One of the big differences that you need to be aware of immediately is that private disability insurance does not always automatically allow appeals of denials. Some policies do, though many of these policies allow only one. It's very likely that your first step toward an appeal may involve another filing. This whole situation -- determining what your course of action needs to be and then actually taking it -- can be very confusing. It is advisable to speak with a disability lawyer who has experience with private insurance.

Your Records Need to Be Detailed and Complete 

Chances are your denial was partly due to a record-keeping issue, and not necessarily one that your doctor created. Find out from the insurance company what records they wanted to see that they did not. It could be that their offices did not do a good job in getting all your records. In that case, you'll have to go get those records yourself and ensure that the insurance company gets them when you appeal, file another claim, or take whatever steps your policy allows.

Get Your Doctor in on the Act

Sometimes an additional letter from your doctor (or doctors) can help. Maybe the insurance company had the records but didn't tie various treatments or ailments together properly. Letters from doctors detailing your treatment and prognosis could be the key to having your claim finally approved.

And if you are no longer seeing doctors, you need to start. Constant medical treatment, be it physical or psychiatric, is essential to proving that you do need the insurance payout. You may need additional tests as well. Without this care, you might look like you are well on your way to recovering and not in need of the payout.

Do Not Do This Alone

Whatever the reason for the denial, don't attempt to navigate all this alone. Get a lawyer to help you and guide you. The lawyer is likely better at interpreting the policy fine print and can give you strategies for making your appeal or new claim stronger than before.