There are many reasons why a long-term disability (LTD) insurance carrier might deny a claim for benefits, even if one’s medical condition may not allow them to return to work; for instance, missing a required medical evaluation. In other circumstances, the insurer may blame a pre-existing impairment or indicate that you can perform another type of job for which you are reasonably suited to perform.
If you believe you qualify for long-term disability benefits because of an illness or injury that prevents you from working, but your LTD insurance carrier denied your claim, you can discuss your options for pursuing compensation with a lawyer.
Getting Approved for LTD Benefits Is Not Always Easy
If you have an illness or injury that your doctor has said may limit your ability to work for longer than several weeks, you may want to consider filing a claim based on your long-term disability policy. These policies generally have an elimination, or waiting, period before starting, and may kick in after your short-term income options are exhausted.
In some cases, though, the claim may be denied, and you may have to take a look at your policy or the denial letter to try to figure out why.
Generally, in order to have a successful claim, you may need to have support from multiple parties, including:
- Your employer, possibly including your manager and the Human Resources department; and
- Your doctor.
Why would long-term disability be denied? You may receive a denial if:
- The insurer no longer accepts the medical evidence contained in your file to support your claim of disability.
- Your doctor is not supportive of your claim.
- You have misrepresented your injuries or impairments.
- You have failed to attend for treatment.
- You have failed to follow the advice of your treating doctors.
- You have abused substances.
- You miss a medical evaluation or other required action.
- Your forms are not completed fully and accurately.
- Your forms are not sent to the correct organization completed and on time.
Options for Challenging a Long-Term Disability Benefits Denial in Ontario
If you receive a denial of your LTD benefits claim, this may not be the end of the road. You may have the right to appeal any denial. There are generally two ways to fight a denial of your LTD benefits claim:
- File an internal appeal of your denial with the LTD insurance carrier.
- File legal action to challenge the carrier on their wrongful denial.
While an internal appeal may be useful in some circumstances, it is not always the best route and often results in the same conclusion – a denial.
For many workers who receive a denial, taking legal action may be a more effective approach to challenging the insurance carrier’s decision.
Taking Legal Action to Pursue Compensation Based on Your LTD Insurance Policy
A lawyer may be able to help you understand your policy, determine if you have been wrongfully denied, and handle your legal claim for compensation based on your LTD coverage. If necessary, they may also be able to take your case to court and seek instatement of LTD benefits or settlement of your claim on a full and final basis.
However, there are strict deadlines for taking this type of action in an LTD benefits denial case. The Limitations Act of 2002, S.O. 2002, Chapter 24 only offers two years from the date of your initial denial notification to file suit. Failure to meet this deadline may mean losing the right to challenge your denial.
Talk to a Long-Term Disability Lawyer About Your Denial
At Preszler Injury Lawyers, our long-term disability lawyers have previously served workers who have been denied benefits throughout Ontario. Our team may be able to get to the bottom of your claim and possibly help you sort out any issues or fight a wrongful denial. We understand why LTD insurance carriers deny claims and may be able to help wrongfully denied workers challenge these denials.
If your medical condition that prevents you from working also prevents you from traveling, we can come to you to discuss your case. Call Preszler Injury Lawyers at (416) 364-2000 to learn more about how our team may be able to help.