Managing an illness or injury that leaves you unable to work is incredibly difficult and more common than you think. If you’ve been paying disability insurance premiums and the insurance company you counted on to be there in your time of need has denied your claim, you likely feel lost.
You need those benefits to focus on rehabilitating and rebuilding your life.
If your long-term disability (LTD) claim has been denied, don’t give up hope. In Ontario, about 60 percent of legitimate disability claims are rejected by insurance companies each year. Insurance companies are notoriously tight-fisted and denying claims is how they make money.
Often, an LTD applicant will receive a letter telling them their claim has been denied. It also invites them to appeal the decision. But Samantha Share, Lawyer and Assisting Managing Director at Share Lawyers, an Ontario-based law firm specializing in disability law says, “This appeal invitation is done primarily to appease the applicant and rarely results in a change in the decision. In the meantime, you have no money coming in.”
The LTD appeals process can be long and frustrating. This is why you should have an experienced long term disability lawyer get involved at this stage rather than risking damaging your chances for future success.
Why you should fight a denial
After receiving a denial letter, you may feel like giving up.
The fact is you have been paying premiums directly or indirectly and this long term disability insurance was meant to protect you in case you’re unable to work. If you throw in the towel now, you could be giving up the money that you are entitled to receive.
Why you shouldn’t appeal your denial
The denial letter from your insurance company may give you three opportunities to appeal their decision. This is a routine response that makes it appear as if they care, but they’re really counting on you to give up.
Even though you have the option to appeal, it is not a step you should take on your own.
To appeal successfully can be difficult - you are asking the same people who denied your claim in the first place to reconsider their decision. The insurance companies’ appeals process is complex and can be frustrating to navigate without help.
For your appeal to have any chance of success, you will need to submit stronger medical evidence. There are also strict time limits on being approved your benefits after an initial denial, and appealing can end up wasting the precious time you have to fight back
If you have been denied disability benefits, you can use this free online tool to learn if you have a valid case.
Common reasons a long-term disability claim is denied
Many insurance companies look for reasons to deny long-term disability claims in Ontario. Some of the most common reasons are:
- Filing a claim or appeal late: Insurance policies often stipulate a timeline under which to submit a claim, beginning from the point you first became disabled, but this timeline isn’t always clear.
- You are not “totally disabled”: Insurance companies use the term “totally disabled” because they want you to believe that you need to be paralyzed or in a coma to qualify for long-term disability. “Totally disabled” means that a doctor has confirmed that you’re unable to perform the essential aspects of your own job.
- Insufficient medical evidence: The insurance company may not accept your doctor’s assessment of your disability, especially in cases where your condition cannot be verified through diagnostic imaging or a blood test. This is often the case with mental health claims and chronic pain claims, that cannot be proven through testing.
- Your medical condition is contested by the insurer: An internal medical consultant may review your application and report that your condition is not severe enough to meet the benefits criteria.
- Pre-existing condition: One of the most common reasons for rejecting a claim is the pre-existing condition exclusion clause. If the insurance company determines that you sought treatment before your insurance policy took effect, your claim may be denied.
What to do when your long-term disability claim is denied
If your long term disability claim is denied or if you have questions about appealing your insurance company’s decision, contact the Ontario long term disability lawyers at Share Lawyers. “A disability lawyer can get the process started right away,” says Samantha Share. “They can also make suggestions as to alternate forms of income that may be available to the claimant during the waiting period.”
The longer you wait, the longer you will be without income.
Share Lawyers has over 35 years of experience in long term disability law and can help you win your long term disability benefits case against Canada Life, Desjardins, Manulife, RBC Insurance, and other insurance companies.
Consultations are free and there are no fees unless you win your case. Call Share Lawyers today at 1-888-777-1109 or visit them online here.