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Professionals invest years into building their careers. Whether you’re a lawyer, accountant, engineer, healthcare provider, consultant, or business owner, your professional success is tied directly to your ability to think, communicate, and perform specialized work. When illness or injury adversely impacts those abilities, private disability insurance is meant to protect your livelihood.
The decision to apply for private disability benefits — and then dealing with a denial — can be overwhelming. Policies are dense, the requirements are strict and insurers often scrutinize claims from high‑earning professionals more carefully.
Insurance companies deny professional disability insurance claims for many reasons. The most important first step after a disability claim denial is to understand exactly why your claim was denied.
This guide walks you through how to make a disability income claim, what evidence you need, how partial disability benefits work, and what to do if your insurer denies your claim. The goal is to help you protect your income and navigate the process with confidence.
Private disability insurance includes:
These policies are different from group long‑term disability (LTD) benefits, which are usually provided by an employer as part of an employee benefits package. Both group LTD and private disability income policies will replace a portion of your income if you become unable to work due to illness or injury. The most significant difference is the definition of disability.
Most private policies pay benefits if you are disabled from your own occupation. Group insurance LTD policies often pay benefits if you are disabled from your own occupation for a limited period of time and then the definition changes to whether you can perform another occupation. Private policies can offer other benefits such as business overhead insurance or partial disability benefits.
They are often more customizable, more expensive, and provide increased protection — but they also come with unique requirements.
Professionals often choose private disability insurance because:
These advantages also mean insurers examine claims carefully, especially when the professional has a high income or a specialized role.
Many professionals wait too long to apply. They reduce their hours, delegate tasks, or push through symptoms — often at the expense of their health. These actions will allow you to continue to work but they could have an adverse impact on your benefit amount by reducing your income prior to claiming disability.
You should consider applying when:
At the time of application, your symptoms must be present and properly documented. It is required to submit all necessary forms and medical evidence within the specified days, as missing even a single deadline can result in an automatic, technical denial of your claim.
Private disability policies often require you to be under the regular care of a physician and unable to perform the substantial duties of your own occupation. Early documentation is key.
Before applying, review:
It is crucial to understand your policy’s definition of disability, as this will directly impact the insurer’s decision on your claim. The own occupation definition is especially important for professionals. It determines whether you are considered disabled if you cannot perform your specific professional role, even if you could technically work in another capacity.
Once you realize you cannot continue working at full capacity, notify:
You will receive:
Applications for disability income benefits often require detailed financial information, including:
This is because private disability benefits are tied directly to your pre‑disability income.
Be aware that claims can be denied if any required paperwork is missing or if the application is submitted late.
Medical evidence is the foundation of every private disability claim. Insurers want proof of:
Insufficient or missing medical evidence is the most frequent reason for professional disability insurance denials. Depending on the illness, insurers tend to prefer objective medical evidence, such as MRIs, CT scans, or other test results, to support your claim. Reports from specialists are required and can carry more weight than those from family doctors, and detailed narrative reports from specialists are especially useful for strengthening your case. Insurers may deny claims for subjective conditions due to a lack of objective evidence, and differences between your own doctor and the insurer’s medical consultants can lead to denial. The insurer’s medical consultants may interpret your condition as less severe than your own doctor does, which can impact the outcome of your claim.
For professionals, functional limitations are especially important. Insurers want to know:
Conditions that commonly affect professionals include:
These conditions often fluctuate, making detailed documentation essential.
Your claimant statement is your opportunity to explain:
Tips for completing your forms:
Professionals often understate their limitations because they’re used to high performance and pushing through discomfort. It is important to be honest and detailed in your description because insurers rely heavily on your written explanation.
In addition to your forms, consider including:
Private insurers often request additional information throughout the process. Respond promptly and keep copies of everything.
Remember, missing supporting documentation can delay or jeopardize your claim.
Private disability policies require you to be under the regular care of a physician. Insurers expect you to follow reasonable treatment recommendations, such as:
Noncompliance with recommended treatments—such as missing appointments, having treatment gaps, or declining therapies—can result in claim denial. Continuing treatment and following medical advice throughout the dispute is essential to demonstrate the persistence of your condition.
If you cannot tolerate or afford certain treatments, document the reasons. In the Canadian healthcare system, we are plagued by a lack of ready availability of treatment. If you are on a waiting list or have no ready access to recommended treatment, document that fact. Insurers may deny claims if they believe you are choosing not to participate in appropriate care.
Not every disability forces a complete stop to work. Many professionals experience a gradual decline in functioning, fluctuating symptoms, or conditions that allow them to work some of the time but not at their previous capacity. Private disability insurance recognizes this reality through partial disability or residual disability benefits.
Partial disability benefits typically replace a portion of your lost income when you can still work part-time.
These benefits are critical for professionals whose income depends on consistent performance, billable hours, or specialized cognitive or physical abilities.
Partial disability benefits provide income support when you are:
These benefits help replace the income you are unable to earn because of your disability.
Unlike total disability benefits, which require you to stop working entirely, partial disability benefits allow you to:
Most insurers calculate partial disability benefits based on:
Payment of partial disability benefits typically begins after the elimination period has been satisfied, and the amount of payment is determined by the percentage of income lost due to the disability.
Some policies pay a proportionate benefit, while others guarantee a minimum benefit during the initial months of partial disability.
Professionals should review:
Professionals often face unique challenges when illness or injury affects their ability to work:
Partial disability benefits allow you to:
Because partial disability claims involve reduced capacity, insurers often scrutinize them closely.
Strengthen your claim by:
A denial can feel devastating, especially when your income and career are on the line. But denials are common — and they are not the final word.
Disability claim denials happen frequently, as claims are denied for reasons such as insufficient medical evidence, policy exclusions, or results of medical reviews. However, you can use the internal appeal process to request that the insurance company reconsider its decision.
Denial letters often cite reasons such as:
Insurance companies frequently point to the policy’s definition of ‘total disability’ as a reason for denial, arguing that the claimant does not meet this specific requirement.
You are entitled to the insurer’s complete file, including:
Insurance companies may also monitor your social media or use surveillance, and innocent activities—such as photos or posts—can result in a denial if they are interpreted as evidence that you are not totally disabled.
This file often reveals the real reason for the denial.
Internal appeals rarely succeed because they rely on the same evidence and are handled by the same insurer. Experienced lawyers with extensive experience in professional disability insurance denials can provide valuable advice and help you explore your legal options. Consulting with legal professionals can help you make an informed choice about whether to appeal or proceed with a lawsuit, and disability lawyers can help you understand the reasons for your claim denial and guide you through the appeals process.
You should not delay in getting legal advice to clarify definitions and deadlines following an LTD denial. A disability lawyer can:
Your ongoing medical records will be crucial if your case proceeds to litigation.
A denial can trigger stress, anxiety, and feelings of hopelessness. Support from healthcare providers, family, and legal counsel can help you stay grounded. Hiring a lawyer who is knowledgeable about disability law can provide you with hope about the process and support and knowledge to deal with your insurer.
Private disability insurance is meant to protect your income when illness or injury prevents you from working. Whether you’re preparing your first application, exploring partial disability benefits, or responding to a denial, the right guidance can make all the difference. With strong medical evidence, clear documentation, and knowledgeable legal support, you can protect your financial stability and focus on your health. Contact Burn Tucker Lachaîne today by texting at 613-777-0992, calling at 613-777-3301 or visiting our website.
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