Why Was My Long-Term Disability Claim Denied?

According to the Canadian Breast Cancer Network (CBCN), approximately 30% of adults in Canada have access to a long-term disability (LTD) insurance policy. However, it is not uncommon for insurance companies to deny policyholders’ long-term disability claims when people are unable to work and earn a living.

Getting your long-term disability claim denied can be frustrating and overwhelming. However, do not be surprised if you receive the denial letter, as Canadians have some of the highest LTD denial rates in the world.

If your LTD claim was denied, consider speaking with a long-term disability lawyer in Toronto to discuss whether or not you can appeal the denial.

Top 5 Reasons Long-Term Disability Claims Are Denied in Ontario, Canada

There are five common reasons why a large percentage of long-term disability claims are denied in Ontario and other parts of Canada:

1. Insufficient medical documentation.

Insurance companies require policyholders to provide all available documentation proving their long-term disability. A lack of sufficient medical documentation is likely to result in the denial of your LTD claim.

2. Your condition does not meet the policy’s definition of long-term disability.

The insurance company may deny an LTD claim by arguing that the policyholder’s medical condition does not meet the definition of a long-term disability under the policy.

3. Your condition is excluded from the policy or you have a pre-existing injury.

Some long-term disability insurance policies exclude specific disorders and conditions. An insurer is also likely to deny your LTD claim if you have a pre-existing injury.

4. The insurance company disagrees with your doctor’s opinion.

Insurance companies have their own doctors who review policyholders’ medical documentation to determine if their situation warrants LTD benefits. If the insurer’s doctors disagree with your physician’s opinion, your claim can be denied.

5. The insurance company believes they observed you performing activities that are not consistent with the alleged disability.

Often, insurance companies hire private investigators to conduct surveillance on policyholders’ daily activities to find sufficient grounds to deny a claim. If you were seen performing activities that were not consistent with your alleged long-term disability, the insurance company is likely to deny your claim.

If the insurance company decides to deny your long-term disability claim, it is legally required to provide a letter explaining the reason for the denial. If you believe that your insurance company acted in bad faith when it denied your claim or provided inadequate benefits, consider contacting a knowledgeable lawyer to explore your options.

Contact a Long-Term Disability Lawyer in Toronto

If your long-term disability claim was denied, consider speaking with a skilled lawyer to determine if there is anything you can do to appeal the insurance company’s decision and obtain the benefits you deserve. Unfortunately, sometimes the appeals process is no more than a rubber stamp for the insurance companies previous denial, which is why you need the advice of an experience Long-Term Disability Lawyer.

A long-term disability lawyer Toronto will review your case and help you get the most out of your LTD insurance policy by:

● Evaluating your policy to determine whether the insurer acted in bad faith when it denied your claim
● Gathering the necessary evidence and documentation to support your long-term disability claim
● Help you navigate through the complex maze of Long-Term Disability forms
● Obtaining a comprehensive medical opinion from your physician to convince the insurance company that you have a qualifying disability
● Consulting with experts, including vocational experts, to establish the extent of your disability
● Helping you appeal the denial of your LTD claim

At Ristich Law, we put the needs of our clients first and have the necessary resources and expertise to help you with your long-term disability claim. We can develop your LTD claim from scratch or start working on your case if your claim has already been denied. Contact us to schedule a free case evaluation with our long-term disability lawyer Toronto by calling (416) 204-0450.