Filing a disability claim without a consistent treatment history can be difficult, but it is not impossible. Insurance companies typically expect regular appointments with a family doctor, ongoing records of medical care, and comprehensive medical records to support a claim. However, some people have gaps in treatment for reasons such as illness setbacks, financial hardship, or problems accessing care—these cases still deserve careful review and consideration instead of automatic denial.

The Treatment Gap Problem in Disability Claims

A critical issue for Canadians seeking disability benefits is treatment gaps—periods without active medical care or appointments. Insurance adjusters often equate these gaps with questionable severity or commitment to recovery, making claims more likely to be denied. This is especially true for employer-based long term disability plans where ongoing, detailed records are key.

Why Insurers Care About Consistent Treatment

Insurance companies prioritize regular, consistent treatment as proof of genuine disability. They believe ongoing doctor visits, medication, and specialist referrals show real effort and severity.

• Regular doctor visits show ongoing impact of a condition.

• Adhering to treatment plans demonstrates effort to recover.

• Up-to-date medical records offer clear evidence for every stage of a claim.

• Detailed family doctor notes provide professional insight and credibility.

Any gaps can be seen as "red flags" and ultimately result in the claim being denied for insufficient medical documentation or lack of consistent evidence.

Legitimate Reasons for Gaps in Treatment

Many Canadians face treatment gaps for reasons beyond their control. These circumstances are legitimate and should be documented and explained within a disability claim.

Access Barriers

Getting medical care is not always straightforward.

• Rural residents might endure longer wait times for specialists.

• Shortages of therapists, specialist clinics, or accessible transportation can cause delays.

TIP: Documenting attempts to access care and any referrals is critical.

Financial Constraints

Out-of-pocket costs and limited insurance coverage are real obstacles.

• Medications and therapies not covered by disability plans can result in missed treatments.

TIP: Logging financial challenges and discussing alternatives with your doctor help defend the disability claim.

Medical Advice

Sometimes, gaps in treatment are recommended by healthcare professionals.

• Some chronic or episodic conditions are managed with "watchful waiting" or periodic assessment.

TIP: If medical advice suggests fewer visits, get that recommendation in writing.

Personal Circumstances

Life events such as family emergencies, travel, severe symptoms, or mental health crises can interrupt treatment.

• Documentation from your family doctor about personal barriers is important.

TIP: Open communication with healthcare providers and your insurance company protects your disability claim.

Strategies to Strengthen a Disability Claim Despite Treatment Gaps

Overcoming gaps in medical treatment does not mean a disability claim will fail, but proactive strategies are essential for approval.

Document Everything

Thorough and organized evidence is key.

• Keep copies of all test results, doctor's notes, and specialist referrals.

• Use a comprehensive disability journal to record symptoms, work impact, missed days, and treatments.

Alternative Evidence

If regular appointments are not possible, supplement with other forms of proof.

• Functional capacity evaluations (FCEs) or occupational assessments can show how symptoms affect work.

• Objective medical evidence—e.g., X-rays, MRI, bloodwork, notes from specialists—addresses insurer concerns.

Clear Explanation

Provide your insurance company with a detailed, honest account of why treatment was interrupted.

• Written statements from healthcare providers about barriers and recommendations are persuasive.

• Personal statements or journal entries describing how symptoms fluctuate, worsen, or pose hardships can be very helpful.

Proactive Follow-Up

Take extra steps to rebuild the treatment history going forward.

• Schedule catch-up visits or report changes in health promptly.

• Request updated doctor letters summarizing past gaps and future plans.
  

Bertha’s Story: What if Treatment Has Been Inconsistent Over Many Years?

Bertha is 62, and lives in Wolfes Landing, NS. She’s been living with lupus for years, and the symptoms tend to come on suddenly, and then resolve. However, lately they’ve been getting worse, and she’s been struggling with escalating fatigue and memory loss, in addition to the joint pain and skin lesions that have come and gone over the years. These symptoms make it difficult for her to continue her work as a secretary at the local high school.

She would like to apply for LTD, but she’s concerned that the insurance company will not take her claim seriously, since her symptoms have usually gone away in the past. Additionally, the nearest specialist is an hour away, and she had to miss a few appointments last winter due to unsafe driving conditions.

After speaking with a disability lawyer at Share Lawyers, Bertha takes the following steps in order to support her application for long term disability benefits:

• Start a detailed disability journal: Bertha should record her symptoms—including fatigue, memory loss, joint pain, and skin lesions—in a daily log, describing both frequency and how they impact her work and life.

• Request comprehensive medical records: She should gather all available documentation from her family doctor and specialists, even if appointments have been sporadic over time.

• Provide clear explanations for treatment gaps: Bertha can ask her healthcare providers to write a note explaining her missed appointments, emphasizing challenges such as the distance to the nearest specialist and unsafe driving conditions.

• Submit alternative supporting evidence: Work accommodations, letters from her employer, or evidence of declining job performance can help demonstrate the disabling nature of her lupus, especially when symptoms have fluctuated.

• Rebook follow-ups when possible: She should schedule visits with her doctor and specialist as soon as she is able, ensuring her worsening symptoms and ongoing difficulties are documented in new reports.

• Be thorough in the claim statement: When applying, Bertha should include a written summary describing her history of lupus, changes in her health, barriers to treatment, and how her condition now interferes with her ability to work.

With careful documentation, clear written explanations, and ongoing follow-up, Bertha’s disability claim can be strengthened—even with a history of fluctuating symptoms and missed appointments.

How a Long Term Disability Denial Lawyer Can Help

If a disability claim is denied—especially due to inconsistent medical treatment—the best course is to seek legal support immediately.

• Many lawyers offer a free consultation to review the denial letter and next steps.
  

• The legal team can help gather missing or alternative medical evidence, organize records, and communicate with the insurance company directly.
  

• Share Lawyers works on a contingency basis—no fees unless you win disability benefits—offering peace of mind and ensuring access to justice.
  

• Services may include help with lawsuits, mediation, comprehensive documentation review, and representation in legal proceedings.
  

• Appealing alone is rarely recommended; instead, a legal challenge with new or clarified evidence can be much more effective.

Summary Checklist

Filing a disability claim without a consistent treatment history is possible with alternative evidence, clear explanations, and legal support. Insurance companies look for regular medical care, but legitimate treatment gaps happen, and there are ways to address them. A disability lawyer provides practical, compassionate support, especially when a claim is denied.

Checklist for Filing Your Claim:

• Gather all comprehensive medical records

• Start and maintain a disability journal

• Obtain written explanations for missed appointments

• Document financial or access barriers

• Schedule new assessments as soon as possible

• Seek a free consultation a disability lawyer if your claim is denied - book here today

Contact Share Lawyers today and let our experience work for you. Our 35+ years of experience can help you win your case against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and other insurance companies. Our legal team offers a free consultation and works on a contingency basis—there are no fees unless you win your case.