When you’ve worked hard your entire life and suddenly can’t anymore due to illness or injury, disability insurance is supposed to be your safety net. You expect the policy you’ve paid into to provide support—but instead, you receive a denial letter.
Unfortunately, denials of legitimate disability claims are all too common. At RMS Law, we’ve seen firsthand how unjust, confusing, and devastating this process can be. In this post, we’ll break down why insurers deny valid claims and what steps you can take to protect your rights and secure the benefits you deserve.
The Harsh Truth: Denials Are Profitable
It might come as a surprise, but many insurance companies operate on a model that prioritizes profits over people. Denying or delaying disability claims saves insurers money. They’re banking on the idea that you won’t fight back—or that you won’t know how.
These denials often have little to do with the legitimacy of your condition and more to do with administrative technicalities or loopholes in policy language.
Common Reasons Insurance Companies Use to Deny Valid Claims
Even if your disability is real, documented, and supported by your doctor, here are just a few of the tactics insurers use to reject your claim:
1. “Insufficient Medical Evidence”
Insurers may claim your condition isn’t severe enough or doesn’t meet the policy definition of “disability.” They might ignore your doctor’s notes or request irrelevant or repetitive testing.
2. Policy Exclusions and Limitations
Some policies exclude certain conditions (like mental health or “pre-existing” issues), or impose strict time limits. Many claimants don’t realize the fine print can override even solid medical evidence.
3. Surveillance and Social Media Monitoring
Insurance companies may hire private investigators to follow you or scrutinize your social media posts. A single photo taken out of context—like you smiling at a birthday party—can be used to argue you’re not disabled.
4. Paperwork “Errors” or Delays
Failing to submit a document on time or filling out a form slightly wrong can be used to justify a denial. These traps are intentional and rely on your unfamiliarity with the process.
5. Biased Medical Examinations
Insurers often require an Independent Medical Exam (IME), but many of these doctors are selected by the insurer and may minimize or dispute your condition.
What You Can Do if Your Disability Claim Is Denied
✅ Request a Full Copy of Your Policy
Understanding your rights under your specific policy is crucial. A seasoned disability attorney can interpret the dense legal language for you.
✅ Don’t Panic—Appeal Promptly
In most cases, especially with ERISA-governed group policies, you have a limited window (usually 180 days) to file an appeal. Missing this window could end your claim entirely.
✅ Gather All Relevant Evidence
This includes detailed medical records, physician statements, lab results, and even letters from family or coworkers that describe how your condition affects your daily life.
✅ Avoid Dealing Directly With the Insurer
They may try to get statements or documentation from you that can be used against you later. Having legal representation from day one helps shield you from these tactics.
How RMS Law Helps You Take Back Control
At RMS Law, we specialize in helping clients across Pennsylvania, New Jersey, and Delaware fight back against unfair disability claim denials. Our legal team handles:
- Short-Term and Long-Term Disability Claims
- ERISA Appeals and Federal Court Litigation
- Private Policy Claims for Physicians, Executives, and Professionals
- Social Security Disability Applications and Hearings
We take care of the heavy lifting: collecting medical evidence, dealing with adjusters, managing deadlines, and, most importantly, advocating for your right to benefits.
You don’t pay us unless we win your case. Period.
Real Results for Real People
We’ve helped secure over $250 million in disability and injury settlements, and our clients consistently praise our compassion, responsiveness, and deep knowledge of disability law.
Whether your claim was denied yesterday or you’re just starting the process, we can help you get the benefits you’re owed.
Key Takeaways
- Insurance companies frequently deny legitimate claims to protect profits.
- Common denial tactics include technicalities, biased exams, and surveillance.
- A denial doesn’t mean your case is over—appealing quickly is essential.
- RMS Law can guide you through the process with experience, precision, and compassion.
- You have a better chance of success when you don’t face the system alone.
📞 Don’t Let an Insurance Company Decide Your Future
If your disability claim was denied, or if you’re about to apply and want to avoid common pitfalls, contact RMS Law today for a free consultation. Our team is ready to fight for you.