Reasons for Denial of Long-term Disability Claims

As if dealing with chronic pain, physical injury and psychological trauma following an accident aren’t enough, being denied long-term disability income benefits adds even more stress to already difficult circumstances.  Although one can easily feel overwhelmed when receiving the news that owed benefits were denied, do not feel that you need to accept the insurer’s decision without a fight. It is actually less uncommon for insurance companies to deny a legitimate claim for benefits than you may think, even for claimants who were paying faithfully into their company group insurance or an individual plan for years.

This is a good time to consider hiring a personal injury lawyer with success in appealing denied or terminated long-term disability benefits. This decision can empower you to take the steps necessary to get the income that is deserved. In many cases, what may be needed to obtain owed benefits is simply ensuring that your disability application contains all required documentation including medical reports. Your next step may be to file an appeal of the denial and if necessary, you can file a lawsuit against the insurance company for deserved benefits.

Appealing a denial or termination of benefits requires knowledge of the requirements under Ontario insurance legislation and one needs to know what they're doing in order to avoid a repeat of the denial. Although an experienced lawyer will seek to settle things with the insurance company without the need to go to court, being ready, willing and able to take the issue before a judge if necessary in a lawsuit will demonstrate to the insurance company that you are approaching the issue with the utmost seriousness.

Reasons for Denial of Disability Income Benefits

Insurance companies are not always forthcoming when a request is made for the reasons for a denial of disability income benefits. If nothing has changed in terms of your injury and reason for filing since you originally filed your disability income claim, you will need to look to reasons why your claim may have been denied.

In order to qualify for long-term disability benefits, your disability must prevent you from performing your current job, and after two years, you must prove that you still cannot perform at least similar work.  One reason your claim may have been denied is if you failed meet the terms of your disability insurance policy with regards to what the insurance company considers constitutes a disability, which includes the inability to work.

Another reason might be that the mental and/or physical injury or condition that you initially documented do not meet the insurer's requirements for inclusion. A disability that arises from alcohol or drug use, for example, will like not meet the contractual definition of a disability under your insurance contract.

Also problematic for many injured persons is that it is more difficult to provide evidence for conditions such as chronic pain syndrome, depression, post-traumatic stress disorder and chronic fatigue syndrome, from which many Canadians suffer after being injured in a collision or another accident.  Such conditions cannot be proven through standard medical tests, such as X-rays or CT scans, although they are now understood by medical professionals and the courts as being very real conditions that can have a substantial impact on the life of the injured person.

Sometimes disability claims are denied because the claimant simply failed to perform certain tasks as required by the insurance company, such as undergoing a medical examination.  Another common reason for a denied claim is failing to provide specific and required documentation about your injury or other personal information.

In some cases, an application for benefits may be denied because the claimant is seeking disability benefits for a pre-existing condition. If this was the reason given for the denial, you need to check your insurance policy to determine the clause or wording that refers to pre-conditions. In most contracts, pre-conditions are denied for employee disability claims only if the disability claim was submitted in the first year of being insured.

In order to submit a successful appeal, you'll need to cooperate with any requests your insurance company makes for information that helps them to prove your medical condition. An experienced disability claims lawyer can examine your policy and ascertain the shortcomings in your initial claim. Based on his/her experience, your lawyer can best advise you on the type of evidence you'll need to supply to support your disability income claim and the next steps to take in submitting a successful application for benefits.  Remember that your insurer’s initial denial of your disability claim does not mean that you do not have a legitimate claim for disability benefits under the law.