What Happens If My Long Term Disability Claim Is Denied?

CTV reports one in seven Canadians over the age of 15 have some type of disability. This means roughly 3.8 million Canadians are living with a health condition or problem that limits their daily activities. When you can no longer work and maintain the same status of living, you may be eligible for Long Term Disability through your employer or private insurance policy.

However, the system is not flawless. Many people with perfectly valid LTD claims are denied compensation. The denial rate for the government’s CPP disability is 60 percent – so you can only imagine how much higher the denial rate is among private insurers that do not face the same level of transparency and accountability to the general public.

Just because your claim was denied does not mean you are out of options. Our trusted long term disability law firm is ready and able to handle your appeal. Call Preszler Law Firm for a free consultation.

Why are most long-term disability claims denied?

The root cause for LTD claim denials is money. Insurers don’t report year-over-year profits by paying maximum value on every claim. The “reasons” they give you to explain the denial may include:

  • “There is insufficient medical documentation.” Often no additional documents are needed, but the insurer fails to interpret the records adequately. Insurers hope you’ll get scared and give up once you receive the denial letter, but they are more likely to settle quickly when they learn that you are working with a law firm.
  • “You do not meet the requirements for total disability.” The definition of total disability is not a defined legal term. Rather it’s interpreted by insurance adjusters and judges. A “total disability” does not have to be a catastrophic injury or illness. If you are unable to perform essential tasks for which you are suited by training, education, and experience, you can be considered “totally disabled.”
  • “Our medical doctor says you are not disabled.” The insurance’s in-house or hired expert has probably spent less than an hour reviewing your claim. Judges tend to give more weight to the opinion of your own general practitioner, who has taken care of you for years.

How to combat LTD claim denial

Contacting a qualified long term disability lawyer is your best first step because it immediately levels the playing field. By British Columbia law, you have a period of up to two years (from the receipt of a denial letter) to bring a legal claim, so it’s important to contact a law firm as soon as possible.

When you work with a personal injury lawyer at Preszler Law Firm, we take the burden of the claim off your shoulders and handle all communications with the insurer.

Steps to appealing LTD claim denial

Once you’ve contacted a lawyer, you can challenge your claim denial in multiple ways:

  • File an appeal with the insurance company – If you were denied simply because you had to reschedule a follow-up appointment with your doctor, because your doctor failed to provide a timely report, or because you skipped a treatment session, then you have the option to utilize the insurer’s appeals process.
  • File a lawsuit – If you have a fundamental disagreement with the insurer about your diagnosis, prognosis, the nature of a preexisting condition, or your work history, you may file a lawsuit to get the full disability benefits that you are owed. If you are represented by a union, you may plead your case before a tribunal of decision-makers.

A successful appeal results in a settlement offer – which you may accept as fair or reject and continue with the next step of your legal action. Secondary denials or rejection of a settlement is not necessarily the end of the road. Working with a disability claim lawyer will help you understand your full set of legal options every step of the way.