If your claim for disability insurance benefits is denied or terminated (i.e., if the insurance company discontinues benefits they were once paying), the insurance company will send you a letter notifying you of that denial or termination. Depending on the state you live in and the type of policy you have, the insurance company’s denial or termination letter has to include certain information. Most doctors have individual (a.k.a. private) disability insurance policies governed by state law. Below are some examples of denial letter requirements in several states.
Arizona: Under Arizona law, the denial letter should reference any specific policy provision, condition, or exclusion upon which the denial or termination was based. The letter should also provide a reasonable explanation why, given the facts of your claim and/or the applicable law, the insurer believes you do not qualify for benefits under the terms of your particular policy.
California: In California, insurers must advise claimants of the acceptance or denial of a claim within 40 calendar days of receipt of proof of claim, unless they provide written notice of a need for additional time within that 40 days. All denials must be in writing (as opposed to simply given over the telephone), and the denial or termination letter must state reasons for the decision, including reference to specific policy provisions. Like in Arizona, denial or termination letters from California disability insurance companies should provide a reasonable explanation of the basis the insurer relied on in the insurance policy, in relation to the facts or applicable law, for the denial.
Nevada: Nevada disability insurers have 30 working days after receiving properly executed proofs of loss to advise claimants of the acceptance or denial of the claim, unless the insurer advises otherwise within the 30-day period. Nevada law requires that denials be in writing, and it must include whatever specific policy provision, condition or exclusion upon which the insurer based its decision. Just like Arizona and California, Nevada law indicates that disability insurance denial letters should provide a reasonable explanation of the basis the insurer relied on in the insurance policy, in relation to the facts or applicable law, for the denial of the claim.
Utah: Utah follows the same 30-day rule as Nevada with respect to the time the insurer has to provide a claims determination. In Utah, the insurance company must not only put the basis for the denial or termination of the claim in a letter to the claimant, it must also record that basis in its claim file. Consistent with the other states mentioned, insurers are prohibited from denying a claim on the grounds of a specific provision, condition, or exclusion in the policy unless they reference that provision, condition or exclusion in the denial letter.
We always recommend contacting a disability insurance attorney if your claim is denied or terminated. If your denial or termination letter does not include the required information, be sure to let the attorney know, as you may have additional legal rights that you need to enforce.
 A.R.S. § 20-461(15).
 Cal. Code Regs. tit. 10, § 2695.7(b).
 Cal. Code. Regs. tit. 10 § 2695.7(b)(1).
 Cal. Ins. Code § 790.03(h)(13).
 Nev. Admin. Code ch. 686A.675(1), (3).
 Nev. Admin. Code ch. 686A.675(1).
 N.R.S. § 686A.310(1)(n).
 Utah Admin. Code. R590-190-10(2).