It can be shocking and very discouraging to receive a denial letter when you claim benefits under your disability policy. The letter will set out the reason that your claim was denied. The most common reasons for disability denials are:

1. Insufficient medical documentation of disability;
2. The disability is caused by a pre-existing condition and not covered by the insurance policy;
3. The insurance company says that you can perform some other occupation;
4. Missing the deadline to notify the insurance company of the claim;
5. The insurance company denies the claim because surveillance shows the claimant can do their own occupation;
6. The disability insurance provider obtains an independent medical examination which disputes the medical condition;
7. The insurance company’s decision says that there is no coverage for the disability claim;
8. The employer refuses to provide a LTD application to its disabled employee;
9. The disability insurance company disagrees with the treatment being provided by the insured’s own doctor; and
10. Either the insurer makes an error or there is some other mistake in the LTD application process.

Reason #1 – Insufficient medical documentation of disability

The number one reason for a long term disability denial is that the insurance company says that there is not enough medical documentation. Many claims are just not detailed enough because your own doctor wasn’t able to devote enough of their valuable time to complete the time consuming attending physician’s statement. Your disability lawyer will help you to review the application which was provided and suggest areas where your doctor may be able to provide further detail and support for the disability claim.

Reason #2 – The insurance company says that the disability is caused by a pre-existing condition

If your disability benefits are provided in a group insurance package through your employer, there is usually a pre-existing condition exclusion in the policy. If you leave work within a specified time after becoming covered under the policy, you will receive a denial of your benefits if your medical records show that you were receiving treatment for your disabling condition when you became insured. An experienced disability lawyer will be able to examine your application and the medical documentation to advise you on your legal options.

Reason #3 – The insurance provider says that you can perform some other occupation

The definition of disability usually changes after a specific time period. For instance, when short term disability benefits end and long term disability benefit begin, the new definition will usually be harder to prove. Often, after two years of LTD benefits, the disability definition changes from “own occupation” to “any occupation”. If your long term disability insurance was denied for this reason, our long term disability lawyers will review your denial letter and help your obtain the medical evidence which supports your claim.

Reason #4 – The long term disability claim was not submitted in time

Disability insurance policies have strict deadlines for the disability claim to be submitted. If you missed the deadline to submit your claim, your disability insurance lawyer will review your case to find the legal support for the reason that you were not able to complete the application forms. For instance, many employers do not cooperate in providing the claim forms or completing the employer statement which needs to be provided with every claim for benefits. Insurers offer an appeals process which your legal team can review with you in order to determine if you have a reasonable explanation for the delay.

Reason #5 – Surveillance

Insurance companies often hire private investigators to obtain video surveillance of disability claimants. The insurer may have you followed around the grocery store or at your children’s sporting events and then conclude your chronic pain is not totally disabling. Another very common type of surveillance occurs when the private investigator completes a social media search of you in order to show that you have travelled or participated in hobbies which contradict the disability.

The denial letter may say that the disability insurance company has “independent objective proof” that your medical condition is not as you have claimed. You may feel violated by this invasive action by your case manager you have trusted and relied on to pay your disability insurance benefits. Our long term disability lawyers will provide you with a free consultation and evaluate your legal options to prove that you are still totally disabled within the terms of the contract.

Reason #6 – Independent medical examination

Some insurance companies will have you examined by a doctor to determine whether you are totally disabled. The independent medical examination may occur during the application process and before your claim has been accepted or denied. The insurer may also have you examined at the definition change date in order to determine whether you will receive future benefits after you enter the next period of coverage (often referred to as the “any occupation” period). It is common for the medical report to result in denied disability benefits. Our experienced disability lawyers will review your denial letter and obtain a copy of your disability claim file to show that the medical evidence supports your long term disability claim despite the insurer’s doctor’s opinion.

Reason #7 – There is no coverage in the policy for your claim

Disability claims are sometimes denied because the insurance company says that you do not have long term disability coverage. This may occur because your LTD insurance company changed from one provider to a new insurance provider. It is also possible that your employer provided you with forms for their old insurer. Our experienced disability lawyers know how to deal with insurance coverage disputes and provide a free consultation to review your file and outline your legal options.

Reason #8 – The employer refuses to provide the application form for disability

Some employers are not supportive when their employees advise them that they need to apply for LTD benefits. The employment relationship may have soured because you have been ill and needed increasing time away from work. If the employer refuses to provide you with the appropriate forms or to assist you in providing proof of the disability requirements, your disability lawyer can provide the legal support necessary to help you obtain everything required by the insurance company to prove your claim.

Reason #9 – Insufficient or inappropriate treatment for the disability

One of the common reasons that a claim is denied or benefits are terminated is because the case manager does not agree with the treatment plan recommended by your doctor. Claim denial may occur because a medication has been recommended but you have not taken it. Is it possible that your doctor did not record the discussion in their records? When insurance companies review medical records, they often have their own internal medical consultants review the treatment. If their doctor disagrees with your treatment, your LTD claim may be denied or terminated. Your disability lawyer can represent you on a contingency fee basis so that you do not have to pay upfront for legal fees to dispute this denial.

Reason #10 – Error or mistake in the LTD application

Another common reason which may cause a disability claim denial is an error or mistake by the insurer in reviewing your claim, or by you in providing details such as dates or other information which supports your claim. LTD claims can be denied because the employer provided incorrect information about when you started work or when you left work. That mistake could result in your claim being denied because the insurer thinks you are excluded by the pre-existing condition exclusion in your disability policy.

How Our LTD Lawyer Can Help with Your Disability Claim

Our experienced disability lawyers will meet with you in person, by phone or on Zoom to review the reason for your claim denial. We will provide you with a free consultation and discuss the appeals process and your legal options. We have many years of experience disputing denials and terminations of LTD benefits and will provide you with detailed information of your legal options.

Please text 613-777-0992 or call us at 613-233-6898 to schedule a meeting with one of our lawyers.  We will provide a free consultation, in French or English, to ensure that your rights are protected.   In most cases, we can offer to represent you on a contingency fee basis.  This means that you do not pay legal fees unless you win or achieve a settlement on your case.