Why do long-term disability claims get denied?

By Matt Lalande in Long-Term Disability on April 30, 2018

Why do long-term disability claims get denied?

2 Minute read from denied long term disability lawyers Hamiton

Firstly, if you are cut-off or denied disability benefits you have a much better chance of getting your monthly income back on track if you are represented by a Hamilton disability claims lawyer who specializes in the representing denied disability claimants. Our disability law firm serves claimants all over the Province.

Secondly, many group/employer and private disability claims get denied for many reasons – both legitimate claims and not. Disability applications are evaluated by adjusters employed that are employed by disability insurance companies – with the intention that insurers are in the business of profit, not payouts. Insurance adjusters that manage and adjust claims often deal with frivolous applications, fraudulent claims or applications for claimants that are looking for a way out of working. Often, however, even good claims administrators deny legitimate claimants (erroneously or not) unfairly or without merit, despite the claimant having a genuine illness or injury that is supported by medical evidence.

One reason a claim may get denied is insufficient medical records at the time of application. When you apply for disability benefits, supporting medical records from your GP and specialist is the key to a successful application.

Claims can also be denied for insufficient medical evidence or excluded conditions on private policies.   Mostly, however, claims are denied based on adjusters simply deciding that you do not meet the policy’s eligibility requirements.

How do you satisfy your adjuster that you have a valid long-term disability claim?

Most policies issued in Canada contain a definition of “total disability”.  Total disability, within the context of disability insurance, does not mean that you need to be completely incapable of any activity, but rather you must be incapable of engaging in all or at least some of the important duties of a given occupation. More specifically, most disability policies in Ontario provide that total disability within the first benefit payments is established when payments are able to perform the important duties of this phone job even though they may be capable of performing another job or occupation. This is commonly referred to as “own occupation”. After 24 months of disability, policies typically switch (or just use the change of definition) which means that the insured must be unable to perform the activities of any occupation for which you are reasonably suited by education training and experience. Many policies are cut off at the two-year mark or at the change of definition.  In order to satisfy the definition of total disability, you must provide legitimate clinical evidence of your illness, disability or sickness which would satisfy the mandated provisions and requirements in your particular long-term disability policy.

Contact a Disability Lawyer in Ontario

If you have been denied long term disability, it is important to you obtain independent legal advice or retain a long-term disability lawyer they could provide you with your best possible options based on your particular situation. At times, disability companies will simply reinstate payments on the provision of proper and supporting medical evidence, but sadly other times, litigation is required in order to satisfy your burden of proving your total disability. Please do not hesitate to contact our disability lawyers 24/7 at (905)333-8888 to schedule your free consultation.