Texans buy long-term disability policies to keep paychecks flowing when illness or injury strikes. Yet, carriers frequently deny legitimate applications. Knowing the common pitfalls helps you build a file that stands up to scrutiny.
Policy language: “own occupation” versus “any occupation”
Read your contract’s disability definition line by line. Certain coverage triggers benefits when you are unable to carry out the tasks of your own occupation. Others demand proof that you cannot work any job that matches your training. A mismatch between symptoms and the insurer’s definition is a fast route to a denial. The Texas Department of Insurance offers plain-language guides on interpreting policy terms.
Thin or late medical documentation
Adjusters want objective proof: office notes, imaging, lab results, functional-capacity exams, etc. Gaps in treatment or missing test data signal that your condition is unverified.
Missed deadlines and procedural missteps
Most LTD policies (and ERISA plans) set tight windows for giving notice, submitting forms, and filing appeals. One missed date can void coverage.
Surveillance, social media and “gotcha” evidence
Insurers may review Facebook photos or hire private investigators. A single video of you lifting groceries can be used to argue you are fit for work. Policyholders should keep online posts consistent with medical restrictions.
Pre-existing condition and waiting-period clauses
Policies often exclude illnesses treated within a look-back window. This is typically 12 to 24 months before coverage began.
Conflicting medical opinions
When your orthopedist’s letter says you are disabled, but a consulting reviewer claims you can work, carriers side with their own doctor. This is why independent medical exams are pivotal in appeal packets.
Other trip wires
Incomplete vocational forms, like leaving blanks, lets adjusters assume capabilities. Ignoring rehab recommendations, like noncompliance suggests you are not invested in recovery. Finally, self-reported symptoms only, like pain without corroborating diagnostics are easy to discount.
Closing thoughts
LTD insurers deny claims for technical, medical and behavioral reasons. By aligning evidence with the policy’s exact wording, meeting every deadline and anticipating surveillance tactics, Texans can give their applications the best chance of success and avoid the roadblocks that sink so many disability claims.
