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Reasons To Deny Long-Term Disability in Ontario

The process of applying for long-term disability benefits is often far more stressful and demanding than many people anticipate. If you have applied for disability benefits only to have your claim denied, you need to understand that you are not alone, as many applicants have their disability claims denied on the first try. 

Why Does Long-Term Disability Commonly Get Denied In Ontario?

There are a variety of reasons why your claim may have been denied. Understanding why a claim got denied can help you determine what your next step should be. They include:

  • The clock runs out. The first very common reason for a long-term disability denial in Ontario is timing. Most insurance companies have “Proof of Claim” or “Notice” clauses in their contracts that stipulate when a disability claim needs to be filed. If you fail to file in time, your claim can be denied.
  • Your failure to communicate with an insurer. In the course of investigating your claim, the insurance company may have tried to contact you about setting up an interview. Not cooperating can be held against you.
  • Your disability is caused by a pre-existing condition. One of the most common reasons to deny long-term disability in Ontario is pre-existing condition exclusion clauses. These are clauses in your insurance policy that prohibit payments for pre-existing conditions. 
  • Lack of evidence. Your claim could very well be denied if you do not include sufficient paperwork or other evidence supporting your disability claim.
  • Refusal to have an independent medical exam. Independent medical examinations are usually conducted by the doctors the insurance companies are paying, which thus incentivizes the doctors to conclude that you are not disabled, so it is wise to speak to a lawyer before ever agreeing to attend an IME.
  • Not complying with medical advice. Some people may have their disability claims approved and then denied later for failure to comply with their recommended treatment regimens. While you have a right to choose how you handle a medical condition, insurance companies might see a refusal to follow doctors’ orders as a way to avoid working.
  • Changes to the definition of “disability.” Insurance companies’ definition of the term applies to those who cannot work in their field or occupation upon first becoming disabled. But after 24 to 48 months, the definition changes to those who cannot work in any occupation, so you can be faulted for not accepting another line of work.

How Can You Avoid Denials?

Be sure that you file your claim as quickly as possible so you know it has been submitted on time. When an insurance company tries to call you or otherwise contact you about your claim, always respond to their inquiries in a timely manner. If you have concerns about your disability being labeled a pre-existing condition, you may want to talk to your doctor about seeking clarification that the disability is not related to a pre-existing condition.

Be especially sure that you are as thorough as possible when submitting evidence of your condition and its impacts on your ability to work. Complete medical records can help you build a strong case. 

If you are asked to submit to an independent medical examination (IME), speak to a long-term disability lawyer first. Finally, take any medical advice seriously, or risk an insurer deciding that you don’t really have a disability that keeps you from working. 

How Can Derek Wilson Help?

If you’ve been denied long-term disability, there is an internal appeals process, but be aware that essentially, someone will be re-reviewing a claim that a colleague chose to deny. The process doesn’t exactly inspire confidence that you’re getting a fair shake. That’s why getting an experienced and compassionate lawyer on your side at this stage in the process is a good idea. 

Derek Wilson Personal Injury Law has a unique advantage because he specifically worked for insurance companies prior to going into plaintiff legal practice. This level of experience is extremely helpful because he knows what moves to anticipate on the part of the insurer, and how to successfully negotiate with them on your behalf. 

Derek Wilson can also pledge complete and undivided attention to your case because he limits the number of cases he handles, and he never delegates the cases to any junior lawyers. When you hire Derek Wilson to be your lawyer, he will be the lawyer who is actually representing you throughout your case.

Derek Wilson handles cases in all areas of Ontario including St. Catharines, Welland, Cambridge, Brampton, Kitchener, Mississauga, Brantford, Lincoln, Grimsby, Milton, Niagara Falls, Stoney Creek, Guelph, Hamilton, Burlington, and Oakville. He also handles every case on a contingency fee basis, meaning that you will not pay anything upfront and there will instead be a percentage of your award based on the total damages recovered.  

Call 905-769-0418 or toll-free at 1-855-769-0418, or complete an online contact form right now so we can review your case. We will then be able to arrange a free consultation to get a better idea of your challenges and how we can help you overcome them.

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