Alice Turing
According to recent figures, 9.2 million people in the U.S. had disability insurance in 2022. Known as Social Security Disability Insurance (SSDI), these benefits are paid out to individuals with disabilities that limit or prevent their ability to work.
In many cases, these claims are processed without dispute, and claimants receive the benefits they need. However, in many instances, disability claims may be denied or disputed by insurance companies, which may try to reduce payouts or withhold them altogether. This can cause financial hardship and emotional distress for claimants who are often already dealing with the challenges of their disability.
It can be helpful to seek assistance from an experienced SSDI lawyer, such as those at Impact Disability Law, who can advise claimants of their entitlements. In this article, we will take a look at some key challenges faced by claimants when filing a disability insurance claim.
Pre-Existing Health Conditions
Most disability insurance policies exclude coverage for pre-existing health conditions. This means that disability benefits may be denied in cases where the insurance company finds that the disability is connected to a health condition that existed prior to the policy’s start date.
For example, an SSDI claim may be filed by an individual who has been diagnosed with rheumatoid arthritis and is unable to work as a result. However, upon review, the insurance company may argue that the claim is invalid because the claimant had been prescribed an anti-inflammatory medication a year before their policy began.
While this may have been for an issue unrelated to their arthritis diagnosis, the insurer may argue that it relates to a pre-existing health condition for which they are now making a claim. As a result, they may be deemed ineligible to qualify for benefits.
Potential Biases in Independent Medical Examinations
Before approving a claim for disability benefits, insurance companies will typically arrange independent medical examinations (IMEs) in addition to any medical evidence submitted by claimants to support their claim.
However, the results of IMEs can often be biased in favor of the insurer and interpret findings in a way that adversely affects the claimant’s chances of receiving benefits. While they are meant to present an impartial and objective assessment of each claim, the doctors who carry out IMEs may be expected to draw findings that favor the insurance company's interests rather than the claimant’s.
In addition to biased findings, insurers may take a short-sighted approach to a claimant’s health by requesting medical professionals to create a return-to-work plan rather than assessing the long-term impact of the claimant’s condition and their ability to return to work.
Insufficient Medical Evidence
Insurers may deny a disability claim due to insufficient medical evidence. They may argue that the medical records provided by the claimant are inconclusive and do not support the case for long-term or permanent disability.
As a result, insurers may offer benefits that do not accurately represent the true value of a claim. The findings from their IME may also be inconsistent with the medical evidence presented by the claimant, resulting in delays or denial of a claim.
By being aware of the potential challenges, claimants can better prepare their case and increase their chances of receiving the benefits they deserve.
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I'm Alice and I live with a dizzying assortment of invisible disabilities, including ADHD and fibromyalgia. I write to raise awareness and end the stigma surrounding mental and chronic illnesses of all kinds.
