You should be able to count on disability insurance benefits if you have an illness or injury that is stopping you from working. Unfortunately, long-term disability claims are often denied by insurance companies.
There are some common reasons for disability claims denials in Canada. Knowing them can help you avoid a denial in the first place. If you have already received a denial letter from the insurance company, don’t despair. There are options to address or challenge the denial, which our Barrie long term disability lawyers will explain below. Of course, if you want to know more or wish to discuss your own LTD claim, we welcome you to reach out to us today.
Common reasons for LTD claim denials
Here is a list of the most common reasons for LTD disability claims denial that our Barrie injury lawyers come across:
Lack of medical evidence. LTD claims are frequently denied due to lack of “objective” medical evidence. The insurance company will say you have not provided them with enough medical documentation to support your disability claim.
Not “totally disabled.” The insurer may point to the definitions (such as “own occupation” vs. “any occupation”) in the insurance policy and deny your claim on the basis that you are able to work in some other occupation.
Surveillance “proves” you aren’t disabled. Insurance companies often hire private investigators to get video footage to contradict disability claims. This type of evidence is often very misleading and of little value, but insurers regularly rely on it to deny LTD claims.
Policy exclusions. LTD insurance policies typically contain a lengthy list of exclusions. Exclusion of coverage for pre-existing injuries and illnesses is a common one.
Their doctor says you aren’t disabled. The insurance company can require you to attend an Independent Medical Examination (“IME”) with a doctor or specialist of their choosing. The IME doctor may disagree with your own doctor’s opinion and state that you aren’t disabled.
Deadlines were missed. Your claim can be denied if it was filed too late.
Treatment compliance. Your LTD claim will be denied if you aren’t following recommended treatment plans or sticking to a rehabilitation plan.
Refusal to participate in GRTW program. The insurer will deny your LTD claim if you unreasonably refuse to participate in a “Graduated Return to Work” program to build your tolerance for work.
How to deal with denial of your long-term disability claim
As you can see from the non-exhaustive list above, there are many reasons for long term disability denials. Some reasons are legitimate—but fixable. Others are completely unjust or due to a mistake on the part of the insurance company.
Regardless of the reason, don’t give up! There are options to address LTD denials. For example, it may be as simple as providing new or better medical documentation. This is especially common in LTD claims involving chronic pain, fibromyalgia, migraines, mental health issues, or other types of medical conditions that can’t be easily seen or measured by diagnostic tests, blood work, or imaging studies.
The most important first step after a disability claim denial is to understand exactly why your claim was denied so you can address the issue(s) squarely. The insurer is supposed to provide you with a written denial letter that explains the reasons the claim was rejected. It’s also strongly recommended that you get a skilled long term disability lawyer on your side. Your disability lawyer will review your denial letter and help you evaluate your legal options.
Depending on the reason for the denial, you can use the internal appeal process to request that the insurance company reconsider its decision. You also have the option of starting a lawsuit against the insurance company. There are deadlines and limitation periods that apply to each of those options, so you should not delay in getting advice about which option is best in your situation.
Get Trusted Legal Advice From A Long Term Disability Lawyer
Barrie disability lawyers at Littlejohn Barristers will assist you by answering all your questions regarding your long-term disability benefits claim. We can help explore your legal options if your claim has been denied and guide you through the appeals process.
Littlejohn Barristers has a team of lawyers who have experience in disability insurance and will review your case with you. There is no up-front fee or cost involved in any initial meeting. If you require a Barrie long term disability lawyer with extensive experience with LTD claims and LTD denials, please do not hesitate to contact Littlejohn Barristers at (705) 725-7355.