Group Disability Insurance and Common Claim Denials

Many employers include group disability insurance in their employee benefits packages. Their insurance companies offer a seemingly straightforward way to secure coverage for you and your family in case you are unable to work.

Over the years, you’ve trusted that if disability strikes, your insurance will provide replacement income when you lose your ability to work due to illness or injury.

Common reasons why group insurance disability claims are denied

  • Failure to meet the definition of disability
  • The insurer disagrees with your doctor’s medical opinion
  • You are not following the insurer’s preferred treatment plan
  • Policy Exclusions
  • Pre-existing conditions
  • Failure to follow claims procedures correctly
  • Insufficient medical evidence
  • The definition of disability has changed from “own occupation” to “any occupation”
  • Failure to meet the definition of disability
  • The insurer disagrees with your doctor’s medical opinion
  • You are not following the insurer’s preferred treatment plan
  • Policy Exclusions
  • Pre-existing conditions
  • Failure to follow claims procedures correctly
  • Insufficient medical evidence
  • The definition of disability has changed from “own occupation” to “any occupation”

Our Services

We provide clear, reliable help for insurance claims. If your claim has been denied or delayed, we’ll guide you through the next steps and stand by your side.

Group disability insurance

Group disability insurance is supposed to help when illness or injury keeps you from working. If you’re having trouble with your claim, our legal team can help you get the benefits you deserve.

Private Disability Insurance Claims

Private disability insurance offers a safety net when you’re unable to work due to health issues. If your insurer denies your claim, we’ll fight to secure the benefits for you.

Loan Insurance Disability Claims

When illness or injury prevents you from working, loan insurance is meant to provide financial relief. If your claim has been rejected, we’ll step in to challenge the decision and protect your peace of mind.

OTIP Disability Insurance Claims

If you’re an educator facing a denied OTIP disability insurance claim, we’re here to assist. We’ll help ensure you receive the support you’re entitled to so you can focus on your recovery.

HOODIP Disability Insurance Claims

HOODIP disability insurance is designed for healthcare workers, but claim denials can happen. Our experienced team will work to resolve disputes and protect your access to benefits.

CAF/SISIP Disability Insurance Claims

Members of the Canadian Armed Forces rely on CAF/SISIP insurance for disability coverage. If your claim has been denied, we’ll advocate on your behalf to secure your compensation.

Critical Illness Insurance Claims

Have you been denied benefits under your critical illness insurance policy? Our team will carefully review your case, explain your rights, and fight to ensure you get the coverage you paid for.

Life Insurance Claims

Losing a loved one is already hard enough without the added stress of a denied life insurance claim. Let us help you navigate the claims process and pursue the financial support you and your family are owed.

Travel Medical Insurance Claims

Unexpected medical emergencies abroad can lead to costly bills. If your travel medical insurance claim has been refused, we’ll work with you to secure the coverage you need to recover those expenses.

Insurance provider coverage disputes

Coverage disputes may arise when your employer changes its group insurance provider at the time you become disabled or if you experience a recurrence of a recent disability.

If two insurers both assert that you are not entitled to coverage with them, it becomes necessary to determine who is at risk to proceed with your claim. We can deal with coverage disputes to ensure that your legitimate claim does not fall through the cracks.

Employer interference/mishandling of benefits

Employers are responsible for informing employees about their benefits package and ensuring they understand the enrolment deadlines. If you’ve been denied benefits due to missing a deadline you weren’t aware of, you may have grounds to seek compensation from your employer.

Additionally, if your disability benefits aren’t calculated based on your actual income because your employer provided incorrect income information to the insurer, you may be eligible to pursue damages through legal action against your employer.

Finally, if your employer refuses to help you understand the process of applying for benefits, we can help you to make sure that you don’t lose entitlement to your disability benefits by missing important deadlines to apply.

Know your rights and act promptly

It is crucial not to delay when it comes to understanding and asserting your rights. Keep in mind that there is a limited timeframe to appeal or contest an insurance claim denial. Act swiftly to protect your interests.

Let our Experienced Lawyers Help

Our disability lawyers are experts in challenging long-term disability denials and claim termination.

If you are facing issues due to your employer interfering with your benefits or coverage or changes in insurance providers, our lawyers can guide you through the process, ensuring your rights are protected.

We advocate on your behalf, helping you navigate appeals and seek the benefits you deserve.

Bilingual Disability Lawyers with the Right Expertise to Represent You anywhere in Canada

While our offices are in Toronto, Ottawa, Hawkesbury and Waterloo, we can be by your side and on your side across Canada, handling matters in the Atlantic and Western provinces as well as Northern Ontario. There is no need for you to travel. We come to you, or we handle your case virtually.

Contact us today at 613-233-6898.

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What Our Clients Say

I couldn't be more pleased with the way my case was handled. Eliane was extremely supportive and worked diligently on my case. Her knowledge and guidance led to a pleasing outcome. Thank you to Eliane, her secretary's, reception and anyone else involved in my case. I wish you all the best in the future. Your an exceptional team. I highly recommend Eliane Lachaine.
5 stars
Helen Schutt
My personal experience in dealing with Alison at the firm was outstanding. She was always available to answer any questions or concerns I had in dealing with the insurance company. Alison was always upfront and honest with me about the results we were able to obtain. She worked hard for me and was very aggressive and no nonsense during our mediation meeting. My Ltd carrier made an strong effort to minimize the benifits I was entitled to, but Alison was having none of that. She got the results we were hoping for. I can't thank Alison enough for the help, and respect she gave me throughout the whole process.
5 stars
Lyle Fisher
My interaction with this law firm has been positive from right from the beginning exploratory conversations, which were handled with sensitivity and clarity, to the end result, which I felt was very fair. I was fully informed about possible outcomes as the process unfolded, so there were no surprises. I highly recommend the law firm of Burn Tucker Lachaine.
5 stars
Debby Clarke
I would highly recommend this firm. My lawyer’s composure, knowledge, work ethic and most of all excellent representation put me at ease during this stressful time. My most sincere thanks for a positive outcome. Thank you Alison!
5 stars
Karen T
My experience with being represented by Alison Gilmour was extremely positive. She took the time to know me as a person Alison carefully presented options and enthusiastically supported my decisions.
5 stars
Laurel Mollison
Alison and her team made this process extremely stress free and would highly recommend them to anyone who needs a disability lawyer. She took care of all the works so I could focus on my health.
5 stars
Kaitlynn Friesen
Forever grateful for the exceptional help, care and knowledge from the team at Burn Tucker Lachaine. Highly recommend to contact for any personal injury journey.
5 stars
Kayla P
Had a great experience with the team at Burn Tucker Lachaîne everyone is very pleasant and thoughtful, Colleen great work, definitely will recommend to family and friends.
5 stars
Lindamir Schuchardt
This team of professionals were able to assist me and I would highly recommend them.
5 stars
Lori Toffolo

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