Appealing Denied Long Term Disability Claims for Physiotherapists
Receiving a denial for an LTD claim is discouraging and stressful. Your focus should be on your health — not navigating paperwork and policies. Having a lawyer review your claim forms, take over communicating with the disability insurer and develop a strategy to attack the denial will be an enormous relief.
Appeals require detailed documentation from treatment providers and a thorough summary of your symptoms and restrictions. Your occupation is a mystery to the insurer – the claims examiner only knows the duties and demands of a physiotherapist from a description provided in a national occupational category database and other reference documents.
It is essential for your appeal to explain the day-to-day tasks you perform, including not only providing treatment and patient care but also the cognitive and mental demands of the other aspects of your role. A well-prepared appeal can clarify how your condition impacts your ability to meet the demands of your own occupation.
Any benefit application from chronic pain, debilitating injury after an accident, rheumatoid arthritis, or multiple sclerosis to the side effects of cancer treatment or Crohn’s disease should detail the full picture of what it means to be totally disabled. Whether your diagnosis came from a family doctor or a specialist, and whether your symptoms are physical, cognitive, or both, long term disability lawyers can help you pursue the benefits outlined in your insurance policy. We advocate for income replacement that allows you to support yourself and your family members, while holding the insurance company accountable for its promises.
With the guidance of a seasoned disability law lawyer, you can ensure that your LTD benefits application is well-positioned for reconsideration. We will communicate with your insurance provider, gather compelling evidence, and represent your best interests throughout the process.
Understanding Your Rights Under Long Term Disability Insurance
Whether you own a private disability income contract or are covered by an employer-sponsored long term disability insurance policy, your benefits are an important aspect of your financial plan and they can be invaluable in the case of a prolonged illness. These policies typically offer disability benefits in the form of monthly financial support if you’re unable to work due to medical reasons.
If you have a private disability contract, you may be covered for replacement income if you cannot perform your job as a physiotherapist but you can perform in another occupation. These policies may also include partial or residual disability income benefits which are payable if you can work but in a lesser capacity.
By contrast, many group insurance disability policies use an own occupation definition for the first two years of benefits, meaning that if you cannot perform the essential duties of a physiotherapist, you are entitled to benefits. After the first initial period of benefits, the definition may change to a more difficult definition often referred to as the “any occupation” period. Many claims are paid initially and then terminate at definition change.
Your policy outlines how long you may receive LTD benefits—sometimes extending up to the point you reach retirement age, depending on the circumstances. Navigating the fine print of long term disability LTD coverage requires skill. An experienced LTD lawyer can help interpret these clauses and ensure you understand your rights at every stage.
Occupational Risks Can Lead to Physiotherapist Disability
Physiotherapists are susceptible to various health conditions due to the physical nature of their work. Constant lifting, bending, and repetitive motion can lead to musculoskeletal issues, while high caseloads and emotional strain may contribute to mental health issues such as anxiety or burnout.
Common disabling conditions include:
- Spinal cord injuries
- Repetitive strain injuries
- Autoimmune disorders like irritable bowel syndrome
- Chronic fatigue syndrome
- Joint deterioration or nerve damage from years of physical work
When such conditions arise, they can make it difficult or even impossible to continue working in your profession safely or without significant pain. If you’re a physiotherapist facing such challenges, it’s essential to document your symptoms thoroughly with the help of your healthcare providers and consider speaking with a disability lawyer who understands the unique demands of your role.
Disability Income Claim Basics
Disability Benefits for Physiotherapists: What You May Be Entitled To
As a physiotherapist, your disability benefits may include a range of supports depending on your disability insurance coverage. These can include:
- Monthly disability income which could continue until retirement age or life depending on the policy terms
- Partial or residual disability benefits if you can work in a limited way
- Business overhead or interruption insurance
- Waiver of premium payments for life and accidental death and dismemberment insurance
The terms of your insurance contract set out the definition of disability, the benefit amount, any exclusionary terms, and the integration of your disability income with other disability benefit coverage such as CPP disability.
What to Expect When Pursuing LTD Benefits
Navigating a long term disability claim as a healthcare professional can feel overwhelming. You’ll be expected to provide extensive medical records, details of your clinical care team, and evidence that your condition prevents you from performing your own occupation.
While insurers have a duty to adjudicate claims fairly and in good faith, complex cases or incomplete documentation can lead to delays or denials. Consulting with an expert disability lawyer early in the process can help ensure that your application is thorough and timely and clearly demonstrates why you are unable to work in your profession as a physiotherapist.
How a Disability Lawyer for Physiotherapists Can Help Challenge Your Denial Letter for Your LTD Claim
When your disability claim has been denied, the next steps can feel overwhelming – you may be tempted to give up. A lawyer with experience in long term disability can help you navigate the process, ensuring that your rights are protected and that the information submitted supports your claim.
From your first free consultation with a lawyer, your legal team will assess the strength of your case, review your policy, and work with your care providers to demonstrate that you’re unable to work due to a serious condition, whether it’s a mental health disorder or some other disabling impairment.
Why You Need a Disability Lawyer—Even Before You Submit a Claim
Most physiotherapists reach out to a lawyer only after their long term disability claim has been denied—but early support can be invaluable. A lawyer can help ensure your initial disability claim includes detailed documentation, occupational information and medical evidence that aligns with your insurance company’s expectations.
Being proactive may increase your chance of approval and reduce delays or disputes over your eligibility for long term disability benefits.
Your Claim Is Denied – What Next?
Once your claim is denied, you will want to reach out to an expert in disability law. Your lawyer will:
- Review the denial letter to identify why your disability claim was declined;
- Identify the areas that need to be addressed to challenge the denial in an internal appeal or by starting a lawsuit;
- Obtain a copy of your LTD policy and disability claim file;
- Gather complete and clear medical documentation;
- Obtain financial and income information to support your pre-disability income and the proper calculation of your benefit amount;
- Summarize the duties and responsibilities of your occupation and identify any information gaps in the insurer’s file;
- Assume the role of communicating with the insurance company so that you can focus on your health and treatment.
The Appeal Process
Most insurance companies offer a right to appeal the denial decision. The appeal right might be summarized as an entitlement to submit “new, unreviewed medical information” in support of the reconsideration request. The problem with this description of the appeal right is that it is clear that the insurer is unlikely to reconsider its own decision unless there is new medical or other evidence to submit.
If your appeal is based on the position that the insurer interpreted your claim incorrectly and misapplied the policy, it is likely that it will not succeed. If that is the case, your lawyer may suggest that you proceed directly to litigation. It is important to get legal advice on this issue because some policies state that you cannot proceed to litigation until you have submitted an appeal.
The Litigation Process
If your appeal is denied or if you are advised to forgo appealing the insurer’s decision, it will be necessary to start a lawsuit. While the majority of disability lawsuits will not proceed to trial, it is important to hire a lawyer who will approach your case as though it will proceed to trial and who is willing to do so in an appropriate case. Burn Tucker Lachaîne PC has a proven track record in litigation with three partners who are certified by the Law Society of Ontario as specialists in civil litigation. It’s important to have a lawyer by your side who is willing to fight when necessary. Insurers pay attention to cases which are approached this way.
Negotiate Settlements
Most income and long term disability lawsuits are settled before trial – often after an examination for discovery or mediation. It is sometimes necessary to proceed to a pretrial if your case does not settle at mediation. Very few disability lawsuits proceed to trial in Canada but if it’s necessary to be ready to try your case to secure a fair settlement, you need a lawyer who is willing to do so.
The majority of disabling diagnosis claims are settled on a lump sum basis. The amount of the claim depends on the amount of your benefit, which is based on your pre-disability income and your benefit calculation provision, the strength of the medical evidence, and the evidence supporting functional restriction from performing your own or another occupation. In far fewer cases, these claims will settle on the basis that the benefits will be payable on a monthly basis for as long as the insurer accepts that the evidence supports your inability to work as defined by the policy.
We Help Physiotherapists Challenge Denied Claims For Debilitating Conditions
As a physiotherapist, your work is physically and emotionally demanding — and when your health prevents you from continuing in your profession, you deserve the support your disability insurance promised.
If your claim has been denied, you don’t have to face it alone. At Burn Tucker Lachaîne PC, a skilled disability lawyer can advocate on your behalf, help you fight back, and give you space to focus on your recovery. Reach out today to protect your future and secure the benefits you’ve earned.
April 14, 2025 
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