Challenges with Private Disability Insurance Claims

As a self-employed business owner or professional, you’ve taken steps to protect your business and income by purchasing a private disability insurance plan, either alongside your group plan or as an alternative.

You relied on your insurance agent to choose the best private plan tailored to your unique needs and your specific occupation. When an accident or illness disrupts your ability to work, it’s natural to expect your insurance benefits to be there to support you when you need them most.

Common reasons why disability claims from private insurers are denied

  • Failure to meet the definition of disability
  • Insufficient medical evidence
  • Failing to follow the insurer’s preferred treatment plan
  • Disagreement with your doctor’s medical opinion
  • The disability results wholly or in part from an excluded condition
  • Failure to follow claims procedures correctly
  • The insurer alleges that you misrepresented your health on the application for insurance
  • The insurer alleges that your occupation or profession can be performed differently (e.g. in a less demanding role or a different setting)
  • Failure to meet the definition of disability
  • Insufficient medical evidence
  • Failing to follow the insurer’s preferred treatment plan
  • Disagreement with your doctor’s medical opinion
  • The disability results wholly or in part from an excluded condition
  • Failure to follow claims procedures correctly
  • The insurer alleges that you misrepresented your health on the application for insurance
  • The insurer alleges that your occupation or profession can be performed differently (e.g. in a less demanding role or a different setting)

Our Services

We offer straightforward and dependable help for insurance claims. If your claim was denied or delayed, we’ll guide you through the process and stand with you every step of the way.

Group Disability Insurance

Group disability insurance should support you when illness or injury prevents you from working. If your claim is denied, we’ll help you secure the benefits you need.

Private Disability Insurance Claims

Private disability insurance provides financial relief if you can’t work due to illness. If your claim is denied, we’ll fight to get you the benefits you’re owed.

Loan Insurance Disability Claims

Loan insurance should cover your payments if you can’t work due to illness or injury. If your claim was denied, we can help you fight for the support you need to stay on track.

OTIP Disability Insurance Claims

Denied an OTIP disability claim as an educator? We’ll help you secure the support you need to focus on your recovery.

HOODIP Disability Insurance Claims

Healthcare workers depend on HOODIP coverage, but denials happen. We’ll resolve your claim issues and protect your benefits.

CAF/SISIP Disability Insurance Claims

CAF/SISIP insurance supports Canadian Armed Forces personnel. If your claim is denied, we’ll work to secure your compensation.

Critical Illness Insurance Claims

A critical illness can turn your life upside down. If your insurance claim is denied, our legal team will review your situation and work to get the benefits you deserve.

Life Insurance Claims

Losing a loved one is hard enough without worrying about a denied life insurance claim. We’re here to help you navigate the process and get the financial support your family needs.

Travel Medical Insurance Claims

Medical emergencies while traveling can be expensive. If your travel medical insurance claim is denied, we’ll work to make sure you get the coverage you’re owed.

Privately purchased insurance policies are often complex

Applications for privately purchased disability plans often contain numerous health-related questions that can be challenging to answer accurately. Once your policy is issued, you may find clauses and definitions that are difficult for the average person to understand. If your claim has been denied due to errors in your application, our experienced lawyers are ready to advocate for the compensation you deserve. We will explore all legal avenues with your insurance company as well as the agent you trusted to protect your interests.

If your agent failed to properly advise you about the insurance or the application or gave you incomplete or inaccurate advice, they may be liable for the loss of your coverage. We have experience suing insurance agents for negligence and know how to prove that the agent failed to protect your interests.

Own Occupation disability policies

Many self-employed individuals, professionals, and business owners choose Own Occupation coverage, expecting it to protect them if they can’t work in their specific job due to accident, illness, or disability, even if they can work elsewhere.

However, making claims on these policies can be challenging. Issues often arise when insurers dispute the definition of “unable to work” or the specifics of the insured’s occupation.

These policies often have partial or residual disability coverage, which is paid if you are able to perform your profession or occupation in a reduced way and at a lower income. Partial disability claims require detailed evidence of financial loss and prior income. We have experience in handling these cases and gathering the evidence necessary to provide your loss of income. Navigating these complexities requires a deep understanding of the policy’s provisions, an area where we excel.

Business overhead expense insurance

Business overhead expense insurance is designed to cover essential business costs like rent, utilities, and salaries for self-employed individuals and small business owners during disability. In the unfortunate event of a health crisis, insurers often scrutinize claims, questioning the extent of the disability or the necessity of the expenses.

Understanding and proving eligibility for these specific expenses requires detailed documentation and a thorough grasp of the policy’s terms. Many find navigating these challenges daunting.

Our skilled lawyers handle business overhead expense claims across Canada. We are here to help you recover the benefits you’re entitled to.

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 handle complex cases spanning various occupations and professions across Canada including:

  1. Doctors
  2. Dental Hygienists
  3. Chiropractors
  4. Physiotherapists
  5. Lawyers
  6. Dentists
  7. Veterinarians
  8. Other professionals and business owners

Let our lawyers advocate for your rights so that you can focus on your health and your business needs in these difficult times.

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.

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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