Challenging Long-Term Disability Claim Denials for Insurance Agents
Challenging a denial isn’t just about providing a diagnosis—it’s about proving gathering enough medical documentation to show that your condition prevents you from performing the core functions of your job. As disability lawyers who focus on professionals, we ensure your role, responsibilities, and impairment are fully documented in language your disability insurer cannot ignore.
Common Reasons for LTD Claim Denials
When it comes to long term disability claims, even seriously ill claimants can face rejection. It can feel like every disability claim will be denied. Insurance companies deny valid claims for a variety of reasons—sometimes citing policy exclusions such as a pre-existing condition or lack of treatment, while other times blaming insufficient patient medical history or missed deadlines.
One of the most common reasons for a denial is the insurer’s belief that your condition doesn’t meet the policy’s definition of term disability or total disability. Conditions like debilitating pain disorders may be dismissed as subjective, even when they severely impact your ability to work.
A disability litigation lawyer can review your claim, identify the exact reasons for the denial, and determine what evidence or documents are missing. Our lawyers understand how long-term benefits carriers operate—and how to counter weak arguments with strong proof. Schedule a free consultation today to learn more about your next steps.
How to Deal with a Denied Long-Term Disability Claim
Working with a skilled disability lawyer can make all the difference. A lawyer will evaluate the insurer’s reasoning, help you gather additional evidence, and prepare a timely and strategic appeal. The key is not to wait too long—long-term policies often have tight appeal deadlines.
Our law firm has helped countless clients get their benefits reinstated or settled for a lump sum payout. We understand how to deal with large insurance companies and know the appeal process inside and out. If your claim was denied, talk to a long term disability lawyer about your legal options during our free consultation.
Disability Insurance for Insurance Agents: What Your Policy Really Covers
Understanding your disability insurance policy is critical—especially if you’re an insurance agent with complex job duties. As someone who has sold this coverage to your own clients, you value long term disability policies and thought that you would be able to rely on it in the event of a your own injury or illness. It can feel like a personal a front when you have dedicated your career to explaining and selling these policies to clients only to find that your own claim is denied.
The Definition of Disability – Own Occupation or Any Occupation
Coverage depends on how disability is defined. For example, under an own occupation standard, you may still qualify for long term disability benefits even if you can work in another field. Other policies shift to harder to satisfy “any occupation” after two years.
The Duties of the Occupation
An essential part of establishing a payable claim is providing detailed information about the duties of your occupation. For instance, the claims adjudicator may assume that the role of an insurance agent is sedentary and can be performed without leaving your home office. An experienced disability lawyer will work with you to provide an accurate description of the demands of your occupation and the restrictions and limitations posed by your illness.
An expert in disability law can interpret the policy language, explain your rights, and help you prove that you are totally disabled based on your current medical status. Don’t wait until a denial arrives—schedule a free consultation with our lawyers and get clarity before it’s too late. A missed limitation period will prevent you from starting a lawsuit to enforce your coverage so it’s important to see legal advice early.
The Role of an LTD Lawyer in Challenging Denied LTD Claims
If your claim has been denied, your best action is to speak with a long term disability lawyer who understands how insurance companies operate. Many insurers rely on contractual exclusions, or lack of detailed clinical records to justify denying benefits—even when your disability is real and work-limiting.
The Appeal Process
Most disability carriers will offer an internal appeals process. As a knowledgeable insurance agent, you may feel that you are able to submit the appeal without the advice of a lawyer. It’s important to remember that you are disabled from working and handling your own appeal will be frustrating and time-consuming. You will also lack the ability to be objective about your own claim. Hiring a lawyer to handle your appeal will allow you to focus on your health and have a knowledgeable expert deal with the insurer.
Litigation
The reality is that most internal appeals are denied. If an essential piece of information is missing and was not available at the time the application was made, the insurer may accept the appeal and pay you your benefits. However, most appeals involve asking the claims examine or their colleague who holds an appeal specialist role to reconsider the denial decision by reviewing the same information that you submitted in support of your claim. Those appeals are rarely accepted.
Most LTD claim denials will require a lawsuit to be brought against the insurer. While the thought of suing a huge insurance company with almost unlimited resources can be frightening, our lawyers know how to handle these claims and get positive results for their clients. We will obtain your claim file, identify errors in the adjudication of your claim and take all of the necessary steps to make the insurer recognize your claim for disability benefits.
The Right Conclusion to Your Case: Settlement or Trial
Very few cases go to trial in Canada and trials against disability insurers are even more rare. We have 25 years of experience dealing with disability insurance litigation and we know what is necessary to force the insurer to recognize the risk of continuing to refuse to settle your case and make a reasonable agreement on your claim. If a fair settlement is not possible, the law partners at Burn Tucker Lachaine PC are all certified specialists in civil litigation by the Law Society of Ontario. We have trial experience and will approach your case with the intention of taking the insurer to task in court if they will not recognize your legitimate claim. It is important to ensure that you hire a lawyer who not only settles claims but, in the appropriate case, will take matters to trial.
How Our Lawyers Can Help Insurance Agents & Brokers With Disability Claims
Our lawyers work with industry professionals like you, providing guidance, support, and legal representation from initial filing, through an appeal and in a lawsuit. We understand how insurance companies assess claims and how to recover your money.
April 25, 2025 
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