Insurance companies deny long-term disability (“LTD”) claims for all kinds of reasons, some of which are completely unfair. The good news is that knowledge is power. Knowing the most common reasons for LTD insurance denials can help you avoid getting a denial letter in the first place. The other good news? If you’ve had your long-term disability claim denied, you still have options.
Common reasons for denial of a long-term disability claim
When it comes to insurance claim denials, long-term disability lawyers have seen it all. LTD insurance claims can be denied for many reasons, big or small, legitimate or bogus. Here are some of the most common reasons why insurance companies deny long-term disability claims:
Missing deadlines. Insurers want timely notice of any claim. Your insurance policy will set out the deadline for you to provide notice. If you miss the deadline and apply for LTD benefits too late, your otherwise valid claim will be denied.
Lack of medical documentation. To be approved for LTD benefits, you must provide proof of your disability (whether it is a medical condition or injury), and proof that your disability is preventing you from working. The types of medical evidence you’ll need depend on the nature of your claim, but generally speaking you will need medical records, pharmacy prescriptions, and results of any objective testing. There will also be claim forms and/or written statements from your treating doctors to submit to the insurer in support of your claim. If any medical evidence is missing or lacking, the insurance company will use that as a reason to deny your claim.
Failure to meet policy definitions. Your disability insurance policy is a contract. It sets out all of the terms that apply to your coverage, including policy definitions, waiting periods, exclusions, and limitations. Your insurer may decide that your condition does not meet the definition of “disability” in the policy and deny your claim on that basis. Or your insurer may cut off your LTD benefits after a certain period of time, arguing that you aren’t “totally disabled.” Each LTD insurance policy is different, so it is important to read and understand the definitions in your specific policy.
Pre-existing condition. Disability insurance policies often exclude coverage for pre-existing conditions. Whether the denial is legitimate depends on how the policy is written and the nature of your pre-existing condition. Factors such as when you last experienced the pre-existing condition and when you last had treatment or took medication for the pre-existing condition can be critical to the outcome of your claim.
Conflicting medical opinions. Your insurance company may send you for an independent medical examination, conducted by a doctor of its choosing. Doctors who conduct these independent medical examinations are often biased in favour of the insurer. They seem to be searching for proof that you are not disabled. These types of “independent” assessments typically result in conclusions that conflict with the treating doctor’s opinion. It should not surprise you to read that in that situation, the insurer will rely on its own doctor and deny your claim.
Options if your long-term disability claim has been denied
If you have received a denial letter, you have options—but you absolutely must act without delay. There are strict deadlines legally for appealing an insurance denial. If legal deadlines are missed, you’ll lose the opportunity to correct mistakes or provide evidence to support your otherwise valid disability claim.
The first step is to determine exactly why your claim was denied. Read the denial letter carefully, as it should set out the specific reason. It may be a simple mistake or technicality that is easily corrected. Or, it may be because of insufficient evidence to support your claim and your inability to work. In the latter case, you will need to gather additional medical documentation and resubmit your claim.
The next important step is to consider hiring a disability insurance lawyer. An experienced LTD lawyer can help you understand the reasons your claim was denied, explain your options, gather new evidence, and appeal the insurance company decision.
There are many benefits to having an experienced and reputable disability insurance lawyer on your side. The LTD insurance appeal process is complicated. When you work with an LTD claims lawyer, you get the benefit of their advice and guidance instead of navigating the appeal process on your own. Your lawyer will advise you on the best options and start legal action if necessary to protect your rights.
Once you hire a lawyer, you also get the benefit of no longer having to deal directly with the insurance company. The insurer must communicate with you through your lawyer. Your lawyer will handle the insurance company and coordinate with your doctors and treatment providers, freeing you to focus on your health.
Worried about denial of long-term disability insurance? Ludwar Law is here to help
If you have questions about a long-term disability denial or are having problems obtaining benefits from your insurance provider, reach out to Calgary-based Ludwar Law Firm today to discuss your situation. Whether you are considering making an application for long-term disability benefits, have already started the process of making a disability claim, or are faced with a denial of your claim, we are here to help.
James Ludwar is a disability insurance lawyer with a proven 27-year commitment to clients involved in disability claims in Alberta and Saskatchewan. James provides clear advice and practical solutions to people who have had their disability claims turned down by insurance companies. To schedule your free initial consultation, call us today at 403-670-0055 (or toll-free 1-877-682-3476) or contact us using our eForm.