Top 5 Reasons Why Disability Insurance Claims Get Denied

Author: Disability Attorneys Dell & Schaefer
Published: 2010/09/17 - Updated: 2026/01/11
Publication Type: Informative
Category Topic: Claims - Related Publications

Page Content: Synopsis - Introduction - Main - Insights, Updates

Synopsis: This information comes from disability attorneys specializing in insurance law and provides practical insights into the most common pitfalls that lead to long-term disability claim denials. The content proves useful for claimants navigating the complex insurance landscape by identifying specific vulnerable areas including changes in disability definitions (own occupation versus any occupation), surveillance tactics used by carriers, inadequate physician documentation, insufficient medical treatment frequency, and the contentious distinction between objective versus subjective medical evidence. People with disabilities and chronic conditions can use this knowledge to strengthen their claims proactively, understanding that insurers expect monthly visits for psychiatric conditions and quarterly appointments for physical disabilities, while also recognizing that many legitimate disabling conditions lack objective test results yet remain valid grounds for benefits - Disabled World (DW).

Introduction

Most Common Reasons for a Disability Insurance Claim Denial

Claimants often ask me what are the most common reasons for a long-term disability claim denial, so I have put together a list of the most five common reasons.

Main Content

1 - When you're definition of disability could change from own occupation to any occupation.

2 - If the disability carrier conducted video surveillance of you. As you go through our website, you can see that we've done multiple videos on video surveillance, and I would encourage you to check those videos out.

3 - If your attending physician is not cooperating in filling out the paperwork for you or is not filling out the paperwork appropriately, that could also be a problem.

4 - If you are not getting the appropriate treatment or not seeing the doctor often enough. The disability carriers often want to see you go to the doctor on a monthly basis, however, you're not required to go that often. As a rule of thumb, we generally say that if you have a physical condition, you should go to the doctor at least once every three months; if you have a psychiatric condition that's disabling, you should go at a minimum of once a month.

5 - A claim is most commonly denied would be for objective evidence versus subject of evidence. The disability carrier would say you just don't have enough objective evidence to support your claim, and that would be something like you don't have an MRI, you don't have a CAT scan, you don't have a lab report, you don't have an X-ray.

The problem is that there are many disabling conditions where you're just not going to get any objective evidence to support your claim, so the carrier puts your back against the wall, which is a problem.

Insights, Analysis, and Developments

Editorial Note: The tension between what medical science recognizes as disabling conditions and what insurance companies accept as "objective evidence" remains one of the field's most persistent challenges. While carriers increasingly demand MRIs, lab work, and imaging to validate claims, countless legitimate disabilities - from chronic pain syndromes to certain mental health conditions - simply don't produce neat diagnostic images. This creates an impossible standard for many claimants who are genuinely unable to work but whose suffering can't be captured on film or in a blood test. The gap between medical reality and insurance requirements suggests the need for more nuanced evaluation protocols that acknowledge the full spectrum of disabling conditions rather than favoring only those that photograph well - Disabled World (DW).