Reasons Why Your Income Protection Insurance Claim may be Denied

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Having income protection insurance can help you financially if you suddenly become ill or disabled. With income protection insurance, you’€™ll have peace of mind knowing that you have a safety net even if you are suddenly unable to work. However, have you imagined just what would happen if you were denied claim for this protection you were relying at? These are just some of the reasons you should be aware of why you could be denied insurance claim.

Having no objective findings

Even though you might be experiencing disabling pain, the claim reviewer may deny your claim if there’€™s no substantial ‘€œobjective findings’€. Reviewers basically like clear medical evidence of physical or mental problems which are backed up by blood tests, X-rays, MRI, etc, and lack of these objective findings may simply result to denied claims.

Pre- existing condition

One of the common reasons you may be denied a claim is the presence of a pre-existing condition. Usually, the policy may allow up to a 12-month waiting period for a pre- existing condition. For example, coverage will begin for a certain medical condition for which you were treated within a specific time period, just like a ‘€œreasonably prudent person would have sought medical care or treatment.’€

If you are not receiving appropriate treatment

Many companies award benefits only after receiving appropriate medical treatment. However, it might result to the insurance company directing the medical care provided to you, and has raised a number of issues.

Self- reported symptoms

Most contracts contain exclusions on conditions that are solely based on self- reported symptoms, such as headache, fatigue, dizziness, and other conditions difficult to document by objective findings.

Not being under the care of a physician

Many policies require that you undergo regular care of a physician, which is even more critical given the fact that you need to have medical evidence regarding your condition. However, this may cause dispute if not stated early in the policy, including the definition of a physician as compared to alternate care providers.

Failing to fulfill the elimination period

Many policies require that you are continuously disabled during the elimination period before you can make a claim, which is typically somewhere between 30 days and 6 months. Therefore, even if you were totally disabled, but are not able to remain so until the end of the elimination period, you may not be eligible to receive benefits.

Waiting too long to file the claim

Most insurance companies allow up to 90 days to file a claim, while others only allow up to 30 days. Make sure you check with your policy, as claims filed too long after the time of service are often rejected.

Incorrect information

One crucial mistake that could lead to rejected claims is submitting wrong information at any stage of the policy. Whether intently or accidentally, no matter how small the detail is, it’€™s a simple ground to deny your claim. To avoid this from happening, make sure your personal information is accurate.

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