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Disability Insurance

What Do I Do If My Disability Insurance is Denied?

Millions of Canadians struggle living with a disability impacting their ability to work and function in daily life. Whether you have a physical condition or ailment caused by an injury, or an “invisible illness” such as a mental health condition, you may be entitled to long term disability insurance benefits. Unfortunately, many British Columbians with valid, recognized disabilities are denied the disability payments they deserve. It’s essential to know that, even if your insurance company denies your claim, you have the option to request disability reconsideration or appeal the denied claim. However, the amount of time you have to do so is limited. Having an experienced long term disability lawyer who can guide you through the process can be invaluable to overcoming a long term disability denial.

Why are Disability Applications Denied?

When your disability claim is denied, the insurance company must provide you with an explanation for your denial. There are a number of common reasons long term disability claims are denied. Request that this reason be provided to you in hard copy and mailed directly to you for your records.

Denial letters often contain one of the following reasons for denied disability benefits:

Lack of medical evidence: This reason means there is a lack of objective medical evidence demonstrating you are too sick or injured to work within your long term disability claim.

Ignoring medical advice: Long term disability applicants are typically required to show they are doing everything in their power to return to work, including seeing a doctor specializing in their medical condition and following prescribed treatments.

You have a preexisting condition(s): The insurance company’s decision may reflect the belief that your disability isn’t the result of a recent injury or illness but is instead the result of a condition you suffered from prior to the start of disability insurance coverage.

Missing medical documentation/records: Your medical documentation, such as medical records, is required to apply for LTD. A denial may be as simple as a missing document or test result.

You don’t meet “total disability” requirements: The phrase “total disability” is common in the insurance industry but is not legally recognized. This term is meant to indicate the insurance company knows you are unwell but believes your injury or illness isn’t severe enough to keep you from working at any available job.

Your condition does not qualify for disability: Insurance companies attempt to avoid paying benefits by claiming only a small number of conditions warrant disability payments. In recent years, the definition has been expanded in BC and nationally to include any condition that causes significant impairment and inability to work. This includes “invisible illnesses” such as mental health conditions.

Your existing disability benefits ended: Benefit recipients are required to reapply every two years. At that time, the insurance company may decide your health has improved enough to return to work. Most companies use what’s called an “any occupation” disability standard after the first two years, meaning you’re only covered going forward if you’re unable to perform any available job.

You’re able to work in another occupation: LTD policies cover two types of disability, “any occupation” and “own occupation.” Companies using the any occupation standard may insist that even though your disability prevents you from working your current (and possibly preferred) job, it does not prevent you from doing other work.

You filed too late: If your current application was appealing a previous LTD denial, you may have filed too late. You’ll want to refer to your employer’s disability policy to determine your exact deadline to appeal.

Insurance company surveillance: Insurance companies frequently employ individuals to conduct video, audio, and online surveillance of those who have applied for or received long term disability benefits. They do this to delegitimize your disability claim and reject your application or revoke existing benefits.

What to Do if Disability is Denied

Being denied LTD benefits can leave you feeling like there’s nowhere to turn. But you aren’t alone. Many applicants are denied on their first application; in fact, over 50% of applications are rejected.

While the provided reason may not explain the entirety of your denial, it can help you and your lawyer strengthen your disability claim for an appeal.

1. Review Your Denial Letter

Insurance companies are required to give you a reason for denying your application. Get your denial letter and review it. Make sure you keep your denial letter somewhere safe in case you decide to appeal and need to refer back to it. If you lose your denial letter, you can request another from your policyholder.

2. Contact a Lawyer

Submitting an LTD application and filing an appeal don’t require an experienced disability insurance lawyer, but it can greatly raise the chance of success. A lawyer will comprehensively review your application and supporting documents to address the reasons for your denial and ensure your application is persuasive and complete. They may also identify additional resources that will support your disability claim.

3. Decide Whether to Appeal the Denial

Appeals must be submitted within two years of a denial. It can take time to complete your disability appeal, including completing any updated medical assessments, so you will want to decide quickly if you want to appeal. A lawyer can help assess your chances of a successful appeal with a no fee, no obligation consultation.

4. Communicate with Your Doctor

A lawyer may encourage you to discuss your disability application with your doctor so that they can better understand how diagnoses, medical tests, and medical records will be used in a long term disability claim application. This may prompt your doctor to perform additional medical assessments to provide more thorough descriptions of your condition, symptoms, and long term prognosis.

If your doctor is a general practitioner and doesn’t specialize in your condition, you might ask them if it’s appropriate to see a specialist. This is a good idea if the reason for your denial includes failing to see a physician who specializes in your condition. A knowledgeable medical specialist may be able to add important details to your LTD appeal. And insurance company approved doctors are often physicians specializing in your specific medical condition.

5. Appeal Your Denial

Once you’ve decided to appeal your disability denial, you’ll want to take the following steps.

  • Strengthen your claim with additional evidence
  • Maintain your treatment plan and follow doctor’s orders
  • Keep a health journal to document your symptoms
  • Prepare your appeal with updated medical assessments

Contact a Lawyer About Your Disability Insurance Claim

If you’ve been denied disability insurance benefits, contact Stephens & Holman for a free consultation. We are proud to serve clients with 25 locations throughout B.C. As a no recovery, no fee legal counsel, we will not hold you responsible for any legal fees should we be unable to successfully appeal your denied disability claim.