4.9/5 | Your Life, Rebuilt
Insurers ask about gaps in medical history because every missing detail can affect eligibility for long term disability benefits and directly impacts how insurers assess a disability claim. Documenting all medical records and offering complete medical documentation gives the best chance of approval for disability benefits, however if there are gaps or missing information in your medical history, it is possible to fill them in and strengthen your claim.
This blog will outline practical steps you can take—from gathering missing records and coordinating with your doctors to providing consistent updates and written timelines—to ensure your claim is as thorough and compelling as possible.
Why Insurers Ask About Medical History Gaps
Insurance companies ask about gaps in medical history to ensure the information provided supports the claim for long term disability benefits. Any lack of medical evidence can raise doubts about the authenticity or severity of a disabling condition. Insurers look for continuous care and consistent documentation to verify that a claimant remained impaired during any periods where medical treatment wasn't documented.
Gaps could indicate periods where the disability did not exist or was less severe.
Missing documentation may lead to disability benefits delays or denials.
Insurers prefer objective, ongoing medical documentation to support a disability claim.
Common Reasons for Gaps in Medical History
Limited Access to Healthcare Providers
Many Canadians experience gaps simply due to limited access to family doctors and specialists, especially in rural areas, which can create inconsistencies in their medical history. If providers are unavailable or waitlists are long, claimants may miss regular appointments, leading to missing entries in medical records.
Delays in referrals can lead to longer gaps in medical history.
Rural communities often struggle with access, making patient care less consistent.
Personal Reasons
Sometimes gaps happen due to personal circumstances, such as family emergencies, work obligations, or struggling to travel for treatment. For example, Nancy, a 42-year-old receptionist, was diagnosed with lymphoma and had difficulty accessing her specialist due to travel challenges.
Nancy’s Story:
Nancy hoped to start treatment soon, but was unable to attend appointments regularly. By journaling her symptoms and every attempt to arrange visits, she created a record showing persistent efforts despite difficult circumstances—a critical strategy for her disability claim.
Mental Health Conditions
Mental health issues can create gaps because symptoms such as depression, anxiety, or cognitive challenges might make it hard to seek or commit to regular care.
Missed appointments due to symptom severity should be documented.
Insurance companies often scrutinize these gaps when reviewing medical evidence.
How to Document Any Gaps in Your Medical Treatment History
Providing detailed documentation is essential when a gap occurs in your medical history. Insurers need to see not just what happened but why there was a break in care.
Provide Alternative Evidence
If unable to see a doctor, use these alternatives:
Keep a disability journal noting symptoms, attempts to seek treatment, and changes in daily life.
Document communications with clinics, specialists, or insurance representatives.
Obtain statements from family, friends, or colleagues about changes in function.
Be Accurate and Honest
Insurance companies value consistency and honesty in medical documentation.
Avoid exaggerating or omitting facts; inconsistencies can lead to denials.
Clearly describe what caused the gap and how efforts were made to address it.
Checklist: Bridging Gaps in Medical History
Checklist Item | Why It Matters |
Keep a daily medical journal | Ongoing evidence for symptoms and limitations |
Save copies of all correspondence | Provides a timeline of patient care |
Make note of appointment attempts | Shows consistent effort for medical help |
Request written supportive statements from doctors | Strengthens narrative for disability benefits |
Gather alternative evidence (family, work, etc.) | Sheds light on the impact during care gaps |
How a Disability Lawyer Can Help You Explain Gaps
A disability lawyer can clarify gaps by preparing detailed submissions, gathering additional medical documentation, and addressing insurer concerns. Lawyers often recommend against appealing denials without first obtaining new evidence—they may suggest legal action or negotiate on your behalf.
Offers strategies to present medical records factually and persuasively.
Collects statements from multiple sources to support continuous patient care.
Ensures all paperwork is consistent and deadlines met.
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.
