The short answer
Disability denials hinge on the definition of disability (own occupation vs. any occupation), surveillance evidence, treating physician opinion vs. insurer's IME, and gaps in medical treatment. ERISA group plans require exhausting the administrative appeal — the record built during appeal is the only evidence a judge sees. Missing the 180-day appeal deadline forfeits everything.
Frequently asked
- Is 'any occupation' a harder standard?
- Much — after 24 months, most policies switch to 'any occupation' and denial rates spike.
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