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Reasons you can be declined disability insurance

​​You can protect your income with disability insurance — if you’re eligible for coverage.

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By

Andrew HurstSenior Editor & Licensed Auto Insurance ExpertAndrew Hurst is a senior editor and a licensed auto insurance expert at Policygenius. His work has also been featured in The New York Times, The Wall Street Journal, Forbes, USA Today, NPR, Mic, Insurance Business Magazine, ValuePenguin, and Property Casualty 360.

Edited by

Anna SwartzAnna SwartzSenior Managing Editor & Auto Insurance ExpertAnna Swartz is a senior managing editor and auto insurance expert at Policygenius, where she oversees our car insurance coverage. Previously, she was a senior staff writer at Mic.com, as well as an associate writer at The Dodo.

Updated|3 min read

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Disability insurance replaces your income when you can’t work because of an injury or illness, but not everyone is eligible for coverage. Depending on your situation, an insurance company may offer you limited coverage — or deny you coverage altogether.

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If you’re having a hard time finding disability insurance at an affordable rate, you can compare disability quotes for free with Policygenius.

What disqualifies you from disability insurance?

You might be disqualified from getting short-term or long-term disability insurance if insurance companies think you’re too likely to make a claim because of your health or lifestyle. 

It can be hard to get disability insurance with a pre-existing condition, especially if it’s ongoing when you apply for coverage. For example, you probably won’t be able to get disability insurance while you’re being treated for cancer.

Having a dangerous job or high-risk habits, like smoking, can also disqualify you from getting disability insurance.

Can your employer deny you disability insurance?

Yes, certain conditions can disqualify you from disability insurance through your employer. That said, your employer can’t deny you disability insurance, but the insurance company that your employer works with can.

While the group disability insurance you get through your work is easier to get than an individual policy, you can still be disqualified from coverage if an insurance company thinks you’re too risky to cover.

Common disability insurance disqualifiers

There are several reasons why you might get declined for disability insurance coverage, including if:

  • You have a pre-existing condition

  • You have an unknown medical condition

  • You have a pending medical procedure

  • A past treatment or condition wasn’t resolved in your records

  • Your job is too dangerous

  • You wrote yourself a prescription

  • You’re considered too overweight or underweight

You have a pre-existing condition

It can be hard to find disability insurance if you have a pre-existing condition, which is a health condition or diagnosis you have before applying for insurance. Some common pre-existing conditions include:

  • Arthritis

  • Asthma

  • Cancer

  • Diabetes

  • Fatigue

  • HIV/AIDS

  • Elective surgery

  • Epilepsy

  • Existing injury

  • Long COVID-19

  • Vertigo

You might be able to get disability insurance with a pre-existing condition, but generally disability insurance won’t cover you if you need to take time off because of a pre-existing condition. And if you’re suffering from your pre-existing condition when you sign up for coverage, you may not be able to get coverage at all.

You have an unknown medical condition

Having a medical condition that doctors can’t identify can also stop you from getting disability insurance. Even if your condition doesn’t seem serious, without knowing for sure, insurance companies can’t tell if it’s a sign of something severe or even life-threatening.

It’s likely insurance companies will ask you to get a doctor’s sign off before you are eligible for disability insurance.

You have an upcoming medical procedure

Tell your insurance company about any medical treatments you’re receiving or planning for before you get disability insurance. If you have a surgery or another procedure coming up, you may not be eligible to get disability insurance until it’s clear your operation was successful.

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Your doctor never resolved your treatment or condition

Insurance companies may decide not to offer you disability insurance if there’s a mistake in your medical records. For example, you may run into problems if you had a condition in the past that wasn’t marked as “resolved” in your records.

You can ask your doctor to make a note in your medical records resolving any past conditions or ask your insurance company for a postponement to give your doctor time to resolve the issue.

Your job is too dangerous

Insurance companies may deny you disability insurance if your job puts you at a higher risk of being disabled, like if you’re a roofer, firefighter, pilot, or construction worker.

Some companies will offer you disability insurance if you have a risky job, but you might have to agree to receiving benefits for only a handful of years after a disability instead of a much longer benefit period.

You’re a doctor and you’ve recently written a prescription for yourself

As a doctor or physician, you can disqualify yourself from disability insurance if you write your own prescription. That’s because insurance companies have no way of knowing whether a prescription you wrote for yourself was for a legitimate reason.

You’re too overweight or underweight

Your weight can affect whether you qualify for disability insurance. Insurance companies can decide not to offer you disability insurance if your weight is either too high compared to the company’s height-weight chart or too low.

Can your disability insurance claim be denied?

You may not be able to make a successful disability insurance claim even if you have a disability insurance policy. There are a few reasons an insurance company may decide to deny a disability claim, like:

  1. Your disability doesn’t match your policy’s definition for disability: You might not be considered if your policy excludes your condition from coverage or you don’t have own-occupation disability insurance and can still do another job.

  2. You can’t prove you’re disabled: Your claim can be denied if the information you gave to your insurance company doesn’t show for certain that you can’t work.

  3. You forget to submit claim materials: Forgetting to send your insurance company medical records, a doctor’s or employer’s statement, and other material can lead to a denied disability insurance claim.

  4. Your statements about your disability don’t match up: Giving inconsistent accounts of your symptoms and other parts of your condition puts your claim in danger of being denied.

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Frequently asked questions

What happens if your disability insurance claim is denied?

If your disability insurance claim is denied, you can ask your insurance company to reconsider. This can involve giving more information to the company about your condition and following any other directions you’re given.

How often is someone denied for disability insurance?

Even if you don’t know how often an insurance company denies someone for disability insurance, you stand a better chance of not being denied if you don’t have a pre-existing condition or upcoming medical procedure, your application paperwork is in order, and your job isn’t dangerous.

Can you be denied for supplemental disability insurance?

Yes, you can be denied supplemental disability insurance. Your insurance company may not let you get a policy if your health raises doubts about how risky you are to insure.

Author

Andrew Hurst is a senior editor and a licensed auto insurance expert at Policygenius. His work has also been featured in The New York Times, The Wall Street Journal, Forbes, USA Today, NPR, Mic, Insurance Business Magazine, ValuePenguin, and Property Casualty 360.

Editor

Anna Swartz is a senior managing editor and auto insurance expert at Policygenius, where she oversees our car insurance coverage. Previously, she was a senior staff writer at Mic.com, as well as an associate writer at The Dodo.

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