Denied Long Term Disability Benefits? Now What?

What do you do if you’ve been denied long term disability benefits?

You’re in a tough situation but don’t panic. I’m going to walk you through those things you can do to build your case and get the help you need.

The first thing to understand about long term disability decisions is that the decision to deny is rarely on behalf of your employer. Long term disability is about whether or not you can work. Your employer is not a doctor (unless you actually work for a doctor!)  and therefore unable to make that decision. Of course there are always exceptions, but generally, your employer is not the enemy.

The second thing to understand that is that, just because you apply for long term disability benefits, doesn’t mean that you qualify. Your insurance company has to believe that you are unfit to do your job before they’ll agree to pay you a benefit.

The third thing to understand is that, when you sue an insurance company about their denying you long term disability benefits, you’re really suing about a breach of contract.

Consider it like this: You have a contact with the insurance company (usually via your employer) that says, if you can’t work due to a medical reason, they will give you x amount of dollars for x amount of time.

This is different to a car accident where you’re suing for an undefined amount of medical expenses and damages.

A long term disability claim is more predictable and, as a result, often resolve more quickly. 1 – 2 years is the norm.

How to Help Your Long Term Disability Case

  1. Submit the Paperwork On Time

Read your policy carefully. Most policies specify waiting periods and qualifying periods. It’s important to work within the timelines your policy dictates. The idea here is that we don’t want to give the insurance company a reason to deny you.

  1. Visit Your Doctor

If you have pain or an issue, going to see your family doctor is the norm for most people. But even if you’re afraid of doctors or simply dislike going, this is something you have to do.

I shouldn’t have to tell you that your family doctor is the one who will refer you to the specialists you need (and remember that, in the province of Ontario, it can take months to be referred to a specialist.)

You can’t skip this step! Beyond being responsible to your own health and well-being, it’s important because your doctor’s report is going to form the foundation of your lawsuit.

  1. Request the Long Term Disability Application package from Your Employer ASAP

 (In bigger companies, your HR representative should be able to provide it to you)  

The package consists of forms that you must fill in as to why you can’t work.

It also includes a form for your doctor to complete – the attending physician’s statement – and forms for your employer to complete that asks for basic information like your job duties, rate of pay, etc.

Although this is not a common occurrence, I should warn you that I’ve seen some large companies hold up their part of the questionnaire.

While most companies are good to their employees, there are other companies that do what they can to avoid having employees on long term disability. I mentioned above that a missed deadline could result in a denial. It doesn’t matter who missed the deadline; it still results in your not getting the benefits you need.

My advice is to be diligent with your employer about getting the forms filled out and submitted on time. Do not assume this will happen naturally. You must champion your own cause.

  1. Follow you Doctor’s Orders

Often one of the conditions of your policy is that, to receive long term disability benefits, you must be under medical treatment.

This doesn’t mean you should be shopping around for treatments; it does mean that you’re expected to mitigate you damages i.e. look after yourself by getting the medical attention you need and sticking to the protocol set out by your doctor.

This can sound a bit arbitrary but it’s not. If you have an injury or condition that’s debilitating enough that you can’t work, you should be doing this anyways.

Furthermore, unless you condition is super obvious, the insurance company is going to want more medical documentation. They may request hospital records, medical records etc. Your medical documentation should be updated regularly – via regular visits to your doctor – to cover any changes in you condition.

  1. Ixnay the Internal Review

When an insurance company makes a decision to deny you long term disability benefits i.e. they don’t believe you’re disabled, they’ll often invite you to make an internal appeal.

I think that’s a waste of time. The insurance company has already made a decision and, unless something striking arises, they’re not going to change it. In my opinion, this is a way to delay litigation, and at this point, it’s time to get a lawyer.

  1. Be Honest

A client’s first instinct can be to hold back information because they are afraid that, if they’re honest about what they can do, they’ll be denied benefits.

The reality is that it’s rare that a person can’t do any aspects of their job after an injury or condition. If you can do part of the job but not all, be honest. If you’re unsure of whether or not you can perform, be honest.

There’s nothing to fear.

If you can only do 30% of your job, they’re not going to bring you back. If you can do 60% of your job and they bring you back on a modified track, isn’t that better for you and your family over the long run? 100% honesty will speak to your integrity and integrity is important when building a case.

  1. Go Easy on Social Media

I used to work defense for the insurance companies and I can tell you first hand that insurance companies rely heavily on surveillance. Social media makes it easy for insurance companies to keep tabs on your condition.

Careful what you post on Facebook, Twitter and other social networks.  A picture is worth a thousand words and can quickly cast a shadow on your integrity.

For example, let’s say you have a bad back and you’re suing for long term disability benefits. You submit all your paper work, doctors’ records, physiotherapy records, etc. The insurance company believes you, but then they see a picture of you water skiing on Facebook. Perhaps the waterskiing doesn’t aggravate your back, perhaps it’s even helpful, but that doesn’t matter. It suggests that you’ve not been honest about your condition and that seed of doubt is enough to impact your case.

My advice is to make sure your social settings are 100% private, and even then, don’t post anything you wouldn’t want the insurance company to see.


8 replies
  1. Jason
    Jason says:

    My wife is 67 and still working full time, on June 8th, 2015 she went into a coma as a result of bleeding AVM. She was operated on but has lost ability on left side of her body so she went on STD and today the insurance company told me that she will not be eligible for LTD because she is over 65. I am trying to find out any available options that she may have? Thanks in advance for any advice!

    • Derek Wilson
      Derek Wilson says:

      Hi Jason,

      I’m so sorry to hear about your wife – that is such a tough situation for your entire family. As I’m sure you can appreciate, I can’t give out legal advice before having reviewed your case thoroughly. The last thing I’d want to do is lead you in the wrong direction because there’s something I didn’t know about your situation. Have you contacted my office yet? I know it’s not the definitive answer you’re probably hoping for, but these things are never cut and dry. If you contact us, we can look at your situation more in-depth and help you to explore your options. In the meantime, I sincerely hope for your wife’s recovery and it’s a good thing that you are out there and asking questions. That’s the first step.

  2. L Davis
    L Davis says:

    Hello. I was recommended for long term disability after exhausting my STI benefits following an ankle injury. I work as a nurse so I am on my feet and moving all shift. An orthopetic surgeon recommended long term until i can be assessed by a second surgeon or until my ankle heals. All paperwork was submitted but I was denied

    • Derek Wilson
      Derek Wilson says:

      Your best bet would be to call the office. In a situation like yours, a lawyer would need to get more information before he or she could say anything. In the meantime, I’m sorry to hear about your ankle. As a nurse, you work hard enough as it is!

    • Derek Wilson
      Derek Wilson says:

      Hi Val. The best thing for you to do is to call the office. A lawyer can’t advise you on a forum like this, so it’s always best for you to call and speak to either the lawyer (or in many cases, you’ll speak to a clerk who will then relay your info to the lawyer). This is how we protect your privacy as well!

  3. C. Coates
    C. Coates says:

    My son has just been denied long term disability. We thought all the medical evidence was more than enough and straight forward. Does he now lose his medical benefits at work, prescriptions etc. Also does his work have to offer some accommodating type of job till this is resolved. We are very confused what next steps to take.

    • Derek Wilson
      Derek Wilson says:

      Thanks for the note. I’m sorry to hear about your son. It certainly does place him (and you, I’m sure) in a stressful situation. I’d need to know a bit more about the details of his situation before I could offer him an opinion. Please feel free to call my office. When you call, you will likely speak with Karen (my clerk.) Her job is to collect information, and the more your son is comfortable sharing, the better. If you mention that you left me this comment on the blog, I’ll be able to connect those dots. Then, if it makes sense, we meet in person where I ask a lot more questions and together we figure out a plan of action. I will say that the sooner you speak to a lawyer (whether that’s me or a colleague) about this, the better, because you will know will you stand, and can begin to plan your next steps.


Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *