Denied Disability Benefits? What You Need to Know

Your job is your livelihood, and you depend on it to take care of your loved ones, your family and yourself.

When your livelihood is jeopardized because you’re unable to work due to mental or physical disability, your first thought may be to turn to private insurance for help.

This is already a tough situation, so imagine how you’d feel if your claim was denied by your insurance company?

Each year, I meet with many people who paid for insurance coverage to help them in their greatest hour of need, only to be told by the insurance company that, now that they need the help, they can’t collect.

The reality is that very few people who are in a situation where they can’t work have the mental and physical fortitude to go up against an insurance company. It’s a David vs. Goliath situation and the stress of dealing with an insurance company of any size – let alone the big companies – if often untenable.

But you do have options.

Perhaps I have read too many John Grisham novels, but helping people sue their insurer for denying them the help they need is what I love best about practicing law.

What Can You Do If Your Disability Benefits are Denied?

1. This is when you need to see a lawyer. Even if you thought you could go it alone, don’t do it. At this point, it will take a skilled lawyer to get your case back on track and see it through to completion.

2. It is very important to document your claim with appropriate medical evidence.

Generally this means making an appointment to see your family doctor so he or she can properly document your illness/injuries.

Schedule enough time to have a long chat with your doctor about your specific job duties and the problems you are having completing them.

For example, if you work around loud noise all day, and you suffer from migraine headaches, you may be unable to work in that environment. Or perhaps you have a shoulder tear and can’t do all the overhead lifting you did a few months ago.

Make sure your doctor writes these things down.

3. Prepare (or have a copy of) your detailed job description before you meet with the professionals (in this case your lawyer, family doctor and medical specialists.)

The accuracy of this job description is everything. It’s impossible to determine whether you’re fit to do a certain job if you can’t describe the duties in detail.

One thing I want to caution: Even if your job description is accurate, it may only tell half the story. I’ve seen many cases where the employer provides a standard job description for a role, yet, when I sit down with the client, I find out that they do a whole lot more than is listed in the job description. It’s often those additional tasks that their disability prevents them from performing.

If a doctor simply reads the description as provided by the company, they don’t have the entire story. That is why it is so important to fully explain your job duties to your doctor.

Even if you are receiving disability benefits, it’s important to be aware of the definitions in your policy of insurance.

Most long term disability policies have a change in definition at the two-year mark. The text changes from ‘an inability to perform your own occupation’ (or something along those lines) to ‘a complete inability to perform any occupation for which you are reasonably suited by way of your education, training or previous experience.’ This may seem innocuous, but it actually represents a big change.

You can often get a sense of what the insurance company plans to do at the two-year mark simply by reading your policy. It will provide clues about when and how the company could stop your benefits depending on the types of questions they ask you in the lead up to that time.

This is why I encourage people to see a lawyer. Important clauses like the ones described above that are both critical and obvious to me, may be overlooked by a layperson. Furthermore, you want to make sure that the lawyer you hire has lots of experience dealing with insurance companies (and winning!)

Not being able to work is hard enough, but the right plan of action can help you protect your family and your future.

Start now if you’ve been denied disability benefits…