Common Reasons for Denial and Long-term Disability FAQ

It can be devastating when your insurance provider denies your request for long-term disability (LTD) benefits, or decides to arbitrarily cut off your policy, especially when you have the legitimate support of your doctor or psychiatrist.

The disability lawyers for Canada at Samfiru Tumarkin LLP have created the FAQ below to answer commons questions about long-term disability claims and the reasons they are denied.

TABLE OF CONTENTS

DOWNLOAD THE PDF

BACK TO FAQS

Why do LTD claims get denied?

Insurance companies deny LTD claims for many [unfair] reasons. In our experience, many of those reasons are simply not supported by the facts, which means that insurers were wrong to deny the claims and can be forced to pay them. Pursuing a wrongfully denied LTD claim is not complicated. At our office we handle many such claims every day in Ontario, British Columbia, and Alberta. We have developed a certain level of respect and reputation with insurance companies such that they know that when we pursue a claim on behalf of disabled person who has been unjustly denied his or her LTD claim, we will not back down, and we will not rest until they pay what our client he or she is owed.

What are common reasons for denial?

There are many reasons for denial. The most common reasons we come across are:

• You are not “totally disabled”
• Your insurer disagrees with your doctor(s) that you are disabled from working
• There is a lack of supporting medical documentation proving that you can’t work
• There is a lack of objective medical documentation proving that you can’t work
• There is no diagnosis for your disability
• You can work in some other occupation
• You have not complied with reasonable treatments
• You applied for LTD too late
• There is surveillance that contradicts the claim that you are disabled
• An insurer assessor says that you are not disabled (this usually happens in the context of an IME – an “Independent Medical Examination”)
• You are refusing to go back to work or to participate in a gradual return to work program
• You are in breach of some provision of your LTD policy
• You are not covered because of a pre-existing condition (exclusion clause under the policy)

There are, of course, many other reasons for denial. These are just the common ones we come across.

What can you do if your LTD claim is denied?

First, don’t panic. You are not alone and there have been many others, like you, who have been unjustly denied LTD by their insurers. If you are disabled and if your doctors/treatment providers have confirmed that you are disabled from working, chances are that we can help you force your insurer to pay.

Second, if you are denied your LTD claim, for any reason, contact us immediately. We will need to review the denial letter and the most recent medical documentation you have in support of your disability. If you are a unionized employee, we will also need to see your collective agreement. We will then review these documents, speak with you about your situation, and let you know what your options are, at no charge. There are almost always options, so don’t give up!

Lastly, understand that insurers often deny claims in error. Their adjusters handle many claims at any given point, and they are not practicing lawyers. We are. We fight for individuals who have been denied LTD  every single day, and we resolve these claims frequently. The key is stand up for your rights and let us help.

What can you expect when you have a case against your LTD insurer?

Once we determine that we can help you and you agree to have us represent you, we file a legal claim against the insurance company, which means that they are only allowed to communicate with us going forward, not with you. This allows you to focus on yourself and your health. We will communicate with your doctors and treatment providers, and we will push back against the insurance company’s unreasonable and unjust denial of your claim.

Our objective is to arrive at a resolution in the fastest and most efficient way possible that will see to it that your insurer pays you what you are owed under the law. This often takes the form of a settlement, rather than a trial. In fact, trials are very rare in LTD cases.

Quite frankly, insurers prefer not to go to trial because it’s very costly. They most often prefer to settle. That said, the amount of the settlement will largely depend on the legal team representing you, their experience, resources, and reputation.

WATCH: Disability lawyer Sivan Tumarkin explains the top 5 reasons disability claims are denied on why you should avoid appealing an LTD claim denial on a Season 3 episode of the Disability Law Show.

Questions? Concerns? Contact Us!

If you are experiencing an issue anywhere in Canada (excluding Quebec) with your long-term disability claim, your employer or the insurance company, we’re here to help. Call our team at 1-855-821-5900, email Help@DisabilityRights.ca, or contact us online for a FREE consultation.

You can also post your specific question about your long-term disability claim online for a quick answer by a disability lawyer at Samfiru Tumarkin LLP, at MyDisabilityQuestions.com.

As Canada’s most positively reviewed disability law firm, we have the experience, tenacity and determination required to provide you with the advice you need, and the compensation you deserve.