Many Canadians pay costly premiums for long-term disability insurance, so it can be incredibly surprising and depressing when you file a claim only to have it denied. The unfortunate truth is that denials of benefits are extremely common, but you need to understand that you will still have options even after an initial denial.
In most cases, insurance companies are certainly hoping that you will receive your denial letter and conclude that is the end of the road, because that will allow the insurer to save significant sums of money. However, appropriate action can help you obtain the benefits that you need and deserve.
Why Are Long-Term Disability Claims Commonly Denied?
There are several different reasons why insurance companies deny long-term disability benefit claims. Following are some of the most common reasons for denials:
- You are not “totally disabled.” Many insurance companies will conclude that an applicant does not satisfy its definition of “totally disabled,” using that as a reason for denying a claim.
- The insurer disagrees with your doctor that you can’t work due to disability. In some cases, the insurance company will simply disagree with the opinion of your doctor that you have a disability that keeps you from being able to work, and may cite other reasons why you should be capable of working.
- There is a lack of supporting medical documentation. Many applicants are denied for failing to include all of the necessary medical paperwork proving their disability.
- There is no diagnosis for your disability. Some people apply for disability without ever seeing a doctor, and these cases are among the easiest for insurance companies to deny because they will use the lack of medical confirmation as evidence of a lack of disability.
- You can work in another occupation. An insurance company may claim that even if your disability prevents you from returning to your normal line of work, you are still capable of working in another profession.
- You have not complied with recommended treatments. Doctors will advise patients to take certain steps to improve their conditions, and insurers will use private investigators to determine that these steps are being followed. Failure to follow a doctor’s advice can be deemed a reason for denying a disability claim.
- You applied too late. You only have a limited amount of time to apply for long-term disability benefits and failure to apply within the appropriate window will usually lead to an automatic denial of benefits.
- Surveillance contradicts your claim. Again, insurance companies invest heavily in private investigators who will use both video and social media surveillance to uncover all kinds of proof that you are not as disabled as you claim.
- Independent medical examination says you are not disabled. The independent medical examination (IME) is used by insurance companies to get medical opinions from their own selected doctors, as opposed to the one you regularly see.
- You refuse to go back to work or to participate in a gradual return to work program. Even though you may be too weak or in too much pain to return to work, an insurer could fault you for not making more of an effort to return to work when it believes you are capable.
- You are in breach of some provision of your long-term disability policy. Your insurance policy is based on a contract you(or your employer) signed with the insurer, and there is often language contained to specifically limit what the company will have to pay. Pay special mind to areas such as subjective conditions and conditions expressly excluded under the policy.
- You are not covered because of a pre-existing condition. Insurance companies often have language in their contracts allowing for denial of claims when there is evidence of pre-existing conditions, so disabilities in which pre-existing conditions are factors are commonly denied.
- You have not sought out accommodations or alternate work. Insurance companies may look to see if you tried to seek any accommodations in your own role at work before you stopped working. The insurer will also look to see if you made any attempts to work at a different kind of job that may be more suitable given your limitations. Whether it is lighter duty, another kind of occupation, or a reduction in hours worked, the insurance company wants to see that you tried all possible avenues before it can conclude that you are completely unable to work.
What Should You Do Post-Denial?
In most every case, it will be in your best interest to immediately consult with long-term disability denial lawyers so you can determine what your best options are moving forward. An experienced long-term disability claim denial lawyer will know how to file a claim and also give you a better chance of being successful.
Another good immediate step to take upon being informed of a denial of long-term disability benefits is to determine how long you have to sue. In most cases, it is two years from the date of the initial denial
You may have to deal with your employer initially too, since they are going to be notified by the insurance company that your claim was denied and you should be able to return to work. You may have to get a note from your doctors stating that you can’t return to work.
You will also need to gather a number of important documents, including the denial letter from your claim representative, a copy of your group insurance booklet describing your long-term disability benefits, a copy of the insurance company’s “claim file”, your union’s collective agreement when applicable, and a copy of medical file going all the way back to when your symptoms started to affect your work.
As soon as your claim for Long Term Disability benefits is denied by your insurer you shouldn’t sit back and wait. You need to act and prepare for what may come next by getting a long-term disability denial law firm on your side.
How Can Derek Wilson Personal Injury Law Help?
Derek Wilson has more than 25 years of experience handling long-term disability insurance claim denials. He knows how to help clients recover the compensation they are entitled to.
Furthermore, he handles every single case himself and never delegates his cases to any junior lawyers. Perhaps the biggest benefit of working with Derek Wilson Personal Injury Law is his previous experience working for insurance companies; he knows all too well how insurers act in these situations and he can anticipate what actions they will take.
Derek Wilson has helped countless clients throughout the Ontario area who had long-term disability benefits denied. He handles cases in such areas as Milton, Mississauga, Kitchener, Brantford, Guelph, Oakville, St. Catharines, Niagara Falls, Cambridge, Burlington, Welland, Brampton, Stoney Creek, Grimsby, Hamilton, and Lincoln.
You will not be asked to pay anything up front because he works on a contingency fee agreement, meaning that you only pay when you get paid. Call us at 289-274-9567 or toll-free at 1-855-769-0418 or complete an online contact form to schedule a free consultation that will allow us to sit down with you and go over all the details of your case so you can know exactly what your rights are and what we can do.