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Common Reasons for Long-Term Disability Claim Denials

If you’ve applied for long-term disability and were denied, you know first-hand the frustrations that can go along with a claim’s denial, adding financial and legal issues to the injuries or illness you are already experiencing. There are various reasons your long-term disability claim will be denied, and understanding the reasons behind your denial is important.

What Are the Major Reasons for the Denial of Long-Term Disability Claims?

There are various reasons your long-term disability claim will be denied, including the following:

  • The insurer states that you do not meet the definition of “disabled.” There are various ways this can happen: you may not meet the definition of “total disability,” you may not have a complete diagnosis, or you may reasonably be able to work in another occupation or field.
  • You have not submitted the requisite paperwork, evidence, or documentation. Generally, your application will need to be accompanied by various types of documentation to evidence your disability and your employment. Your doctor will need to submit a medical report and likely provide medical records, and your employer will need to submit their own report to the insurer. If your application is incomplete or lacks important information, it will likely be denied by the insurance company.
  • There was insufficient evidence of your disability. In order to receive long-term disability payments, you will need to provide important evidence regarding your injuries or illness, including medical reports and documentation. Failure to provide that evidence may mean your claim is denied. In addition, it is not uncommon for insurance companies to engage in some level of observation or surveillance—and, if surveillance contradicts your disability claims, you may be denied.
  • You have failed to participate in rehabilitation or failed to return to work timely. These are also common reasons long-term disability can be denied, including if you did not comply with reasonable medical treatments, or if you refuse to go back to work or return gradually.
  • Your claim presents credibility issues. Ultimately, it is up to the insurance adjuster or claims representative to make a decision regarding whether your claim should be approved. Much of that depends on weighing the credibility you have presented in your application and supporting materials. If your claim does not appear credible, it is possible that it will be rejected.
  • There are errors in your application. Whether you submitted your application too late, forgot to include all necessary information, or you are in breach of your long-term insurance policy, all of these may pose reasons for the denial of your application.
  • The insurer made an error. In some cases, your application and supporting materials may have been perfect and properly submitted, and yet the insurance company issues a denial of your claim. Whether a processing error or a human mistake, it is possible that the denial of your claim stemmed from the insurer’s own error.

What Should You Do If Your Long-Term Disability Claim Was Denied?

Though it may seem most straightforward to appeal the denial of your claim, doing so is anything but, and it is also unlikely to result in a favorable outcome. With your long-term disability denied wrongfully by the insurer, you generally stand a much better chance of a favorable outcome if you file a lawsuit against the insurance company for wrongfully denying your claim. Generally, insurance companies prefer to negotiate a settlement, rather than take a lawsuit to trial, which allows you some room to arrive at a reasonable resolution.

These types of lawsuits can quickly become complicated, however, and you will be well-served by consulting with an experienced long-term disability lawyer. They will discuss your legal rights and options with you, including the option of filing a lawsuit, and strategize with you regarding your next steps. They will review the denial letter, your application, and supporting documentation in order to better understand the reasons for your denial and the best course for moving forward.

How Can Derek Wilson Personal Injury Law Help with Your Long-Term Disability Claim?

The long-term disability claims process in Canada can be complicated and difficult to navigate on your own, particularly while you are trying to piece your life back together after a debilitating injury or accident. Our team is prepared to take all reasonable steps to proceed with your claim and get you fair compensation, having assisted many individuals across Ontario in recovering fair settlements.

My firm focuses only on personal injuries and represents clients with long-term disability claims, and we charge no up-front fees for our consultations. If you are seeking fair and honest legal advice, contact us to discuss your legal rights, options, and potential next steps. Call us at Derek Wilson Personal Injury Law, at 855-769-0418, or get in touch online to schedule a free consultation.

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