Why Disability Insurance Companies Deny Legitimate Claims, and How to Fight Back

Disability insurance is meant to provide financial security when illness or injury prevents you from working. Unfortunately, even strong claims backed by solid medical evidence can be denied.

Insurance companies are for-profit businesses, and every claim they approve represents a financial payout. This can create an incentive to interpret policy terms narrowly, question medical evidence, or use procedural hurdles to avoid paying benefits. Understanding the most common tactics insurers use can help you prepare a stronger case from the start.

Common Tactics Used to Deny Valid Claims

Legitimate disability claims can be denied for a variety of reasons, many of which have little to do with the claimant’s actual medical condition.

Common tactics include:

• Claiming Insufficient Medical Evidence – Insurers may argue that the documentation does not establish your inability to work.
• Relying on In-House Medical Reviewers – These reviewers often never meet you in person, yet may downplay or dispute your limitations.
• Misinterpreting Policy Definitions – Terms like “own occupation” and “any occupation” can be interpreted in ways that reduce your eligibility.
• Surveillance and Social Media Monitoring – Insurers may look for photos, videos, or activities that they believe contradict your claim.
• Procedural Delays – Missing forms, incomplete records, or minor technical errors can be used as justification for denial.

How to Respond When Your Claim Is Denied

A denial letter is not the end of the road. The first step is to carefully review the letter to understand the insurer’s stated reasons for the denial. This will guide your next moves, which should include gathering additional medical documentation, obtaining detailed statements from your treating physicians, and addressing every point raised by the insurer.

For ERISA-governed claims, it is critical to submit all relevant evidence during the appeal stage, as you may not be able to introduce new evidence later in court.

Building a Strong Appeal Strategy

A successful appeal requires more than simply disagreeing with the insurer’s decision. It involves building a detailed, evidence-based response that directly counters the denial. This may include vocational expert reports, functional capacity evaluations, neuropsychological assessments, and other testing that provides objective proof of your limitations.

Our experienced disability insurance attorneys can help ensure that your appeal is comprehensive and that it meets all applicable deadlines.

How Disability Insurance Law Group Fights for Policyholders Nationwide

Disability Insurance Law Group represents clients across the United States in challenging wrongful disability insurance denials. Our attorneys understand the tactics insurers use and how to dismantle them with thorough preparation, strong evidence, and aggressive advocacy. We work closely with medical providers, expert witnesses, and our clients to build the strongest possible case for benefits. Whether ERISA or a private policy governs your claim, we are prepared to stand up to the insurance company and protect your rights.

Contact Disability Insurance Law Group at 954-989-9000 or online today. Our nationwide legal team is committed to helping you fight back against wrongful denials and secure the disability benefits you deserve.