Surprising reasons people are declined for disability insurance coverage

Disability insurance is insurance for your income. Unfortunately, many people get declined for it when they apply. Here are some of the most surprising reasons why.


January 17, 2019

How will you keep paying your bills if you become injured and can no longer go to work? Not everyone has a large savings account they can rely on, and that money can deplete fast. One option is to get disability insurance, which is like insurance for your paycheck.

When you have disability insurance, if you become disabled, then the insurance company will make monthly payments to you that roughly equal your paycheck after taxes. You can choose how long you want to receive these disability benefits when you take out the policy, opting to pay higher premiums in exchange for a longer benefit period and larger coverage amount.

But not everyone is eligible to receive disability insurance. Sometimes, the insurer will decline your application. In other cases, the insurer will only cover you if you agree to a modification of your coverage, which could mean accepting some limitations on your coverage without a resulting premium discount.

There are several reasons why you might get declined for disability insurance coverage. Read on to learn some of the most surprising reasons:

You have fatigue or vertigo

Fatigue may seem like a minor nuisance, but it could actually hint at much more serious medical conditions. For that reason, many people get denied for disability insurance if they have fatigue.

However, the outcome of your application could depend on the duties of your job. If you have a less physically strenuous job, such as accounting or software engineering, then you’ll probably be eligible for disability insurance as long as you agree to an exclusion for your fatigue. That means you’ll receive disability benefits for suffering a disability for any cause other than fatigue.

You may also be required to show that you’re treating the root cause of the fatigue. For example, if your fatigue is caused by sleep apnea, then you’ll need to show regular use of a CPAP machine. You may continue to be declined until you receive treatment.

The same is true for vertigo. As with fatigue, vertigo may be a sign of mental or nervous disorders or physical ailments with long-term consequences, such as a brain tumor. The disability insurance company many require you to undergo a full neurological exam to determine the cause of your vertigo, and your coverage may be contingent on accepting modifications like a shorter benefit period.

You have a pending medical procedure

When you apply for disability insurance, the insurer will ask you a bunch of a medical questions. You’ll have to give not only the medical conditions you’re being treated for but also the types of treatments you’re receiving.

This includes future treatments, such as surgeries. Pending surgeries are a major reason why disability insurance applications get declined. Many people think you can mention the illness or injury, but not pending surgery to treat it.

However, the surgery itself is just as important to the insurer, even if the underlying medical condition is relatively benign. That’s because if complications result from the surgery, you could become disabled. Complications include everything from sepsis to loss of motor ability.

If you have an upcoming surgery, the insurer may decline your application, or it could issue a postponement of your application until after it can be proven that you didn’t suffer any complications from the surgery.

You have a medical condition of unknown origin

Idiopathic medical conditions – for which no cause can be effectively established – may also result in a decline for disability insurance. While the condition may seem benign, it could, like fatigue or vertigo, mask a more severe issue.

Because your doctor doesn’t know what’s causing it, the idiopathic condition could even become worse. The insurer’s underwriters are typically risk-averse, so, in order to make sure you’re getting categorized correctly, they’ll wait to give you disability insurance until more information about your condition is available.

You may need to fully resolve the condition or at least have it under control before becoming eligible to receive disability insurance. You may also apply with a carrier that offers coverage for the condition. A licensed representative from Policygenius can help you find such an insurance company.

In some cases, this could depend on the condition. Shoulder pain could be idiopathic; is it a nerve disorder, or just a muscle injury from going too hard at the gym? Because nobody knows, the insurer may issue you a disability insurance policy with shoulder pain as an exclusion.

Your doctor never resolved your treatment

When doctors are scribbling away in their patients’ medical records, they’re generally writing only for their staff, themselves, and other doctors. Their notes are not geared toward insurance underwriters.

Because of that, the doctor may not describe your condition as “resolved” even if it has been successfully treated. However, during the application process, the insurer will look at your medical records. If a serious injury or illness doesn’t appear to be resolved, then the insurer may decline coverage for you.

To fix this, ask your doctor to make a note in your medical records that the condition has, in fact, been resolved. You may be able to request a postponement if you’re aware that you have an unresolved condition and need time to get your doctor to resolve it.

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

If you’re a doctor, you may have written a prescription for yourself to treat an illness. However, this may make it impossible to get disability insurance. Self-prescribing is an automatic decline, namely because the insurer has no way of independently confirming that the prescription is for a legitimate diagnosis.

Physicians need disability insurance more than most people. Medical school is expensive, and practicing medicine is a highly physical line of work. If you need a prescription, ask another doctor to write it, because going without disability insurance could be a serious risk to your financial health.

Note that insurers generally only look at the last two years of prescriptions, so if you’ve self-prescribed outside of that threshold, then you may be good to apply for disability insurance.

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Takeaway

Disability insurance replaces around 60% of your pre-tax income while you're disabled and can't work.

You’re too overweight – or too underweight

Insurers use a height-weight chart similar to the well-known one for body mass index to determine certain things about your disability insurance coverage. The chart includes a baseline weight per each height. If you’re at that baseline weight, your premiums will be unaffected.

But if you exceed the baseline weight for your height, you’ll be quoted higher premiums. Typically, you’ll be quoted a 25% increase if your weight falls within the first threshold; a 50% increase at the next threshold; and so on, with a 100% increase if you fall within the highest weight threshold for your height.

If you exceed that 100% threshold, however, you may not be eligible for disability insurance coverage at all. You may need to shop around for an insurer who insures people with your particular build. You may also need to lose weight and prove that you can keep it off for at least a year.

The build chart also applies to people who are underweight. If you’re far below the baseline weight for your height, the insurer may decline you. That’s because being underweight could suggest nervous disorder like anorexia or other serious health conditions that could cause disability in the future.

You have a medical condition the insurer won’t cover

This one may not be as surprising as the others. If you’re already seriously ill, insurers are unlikely to cover you. Such uncoverable illnesses include but are not limited to:

  • Renal disorders
  • Blood disorders
  • Cancer
  • Hepatitis
  • Arthritis
  • Multiple sclerosis
  • Parkinson’s disease

However, there are a few surprising solutions. Some substandard carriers will cover you, although you may have to accept low coverage and higher premiums.

Depending on the insurer, you may also be able to get an accident-only disability insurance policy, which only pays disability benefits if you were disabled from a sudden, physical injury. Any injury caused by an uncoverable illness, such as suffering a fall because of Parkinson’s disease or multiple sclerosis, will not yield disability benefits.

You may also be able to get Social Security disability insurance (SSDI). While this option is great if you don’t have any others, SSDI offers much smaller benefit amounts that may not be able to replace your paycheck and pay your bills. To avoid having to rely on SSDI, apply for disability insurance when you’re young and healthy, so if you develop a serious illness later in life you can be covered by your policy.

Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.

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