When you’re facing a serious illness or injury, your health comes first—but if you need to make a claim for disability benefits through an employer-based or private insurance plan in Canada, the importance of consistent medical treatment in disability cases cannot be overstated.

Regular medical treatment and detailed medical documentation are the foundation of a successful disability claim. This guide explains why consistent medical treatment matters, how to avoid common pitfalls, and what to do if your claim is denied.

Why Insurance Companies Require Ongoing Medical Treatment

Insurance companies are in the business of assessing risk and protecting their bottom line. When you file a claim for long term disability benefits, the insurance companyneeds to see proof that your condition is real, ongoing, and serious enough to prevent you from working. This proof comes from your ongoing medical treatment and the records your doctors keep.

What Counts as “Consistent” Medical Treatment?

Consistent medical treatment means more than just seeing your doctor once in a while. It’s about:

• Regular visits: Keeping scheduled appointments with your family doctor and specialists.

• Following treatment plans: Taking prescribed medications, attending therapy, and following through with recommended tests or referrals.

• Documenting symptoms and changes: Sharing updates with your healthcare team and making sure these are recorded in your file.

• Ongoing communication: Letting your doctor know if you have trouble accessing care or if your symptoms change.

Why Do They Require This?

• Medical documentation paints a clear, chronological picture of your health journey.

• Regular appointments and up-to-date records show that your disability is genuine and persistent.

• Ongoing medical treatment demonstrates you are doing your part to recover or manage your condition.

Key Point: If you stop seeing your doctor or skip recommended treatments, the insurance company may question whether your disability is as severe as you claim.

How Inconsistent Treatment Can Undermine Your Claim

Missing appointments, failing to follow your doctor’s advice, or having big gaps in your medical treatment can seriously hurt your claim. Here’s why:

• Insurance companies may argue that your condition isn’t serious if you’re not getting regular care.

• Gaps in medical documentation make it harder to prove that your symptoms are ongoing.

• If you don’t follow prescribed treatment, the insurer may claim you’re not doing everything you can to get better, which is often a reason for denial.

Many disability claims are denied simply because the insurance company says there is “insufficient medical evidence.” This is often code for “not enough regular, detailed records from your doctor.”

Exceptions: When Gaps in Treatment Are Unavoidable

Life happens. Sometimes, you can’t attend every appointment or follow every bit of advice. Here are common exceptions—and how to handle them:

Travel

If you need to travel for family or personal reasons, let your doctor and the insurance company know in advance. Ask your doctor to note the reason for any missed appointments in your records.

Financial Hardship

If you can’t afford certain treatments or medications, tell your doctor. They can document this and may suggest alternatives. Some virtual care options, like Maple, can help bridge gaps when in-person visits aren’t possible.

Limited Access to Specialists

In rural areas or during specialist shortages, wait times can be long. Keep a record of your efforts to get care, including referral letters and appointment requests.

Illness-Related Limitations

Sometimes your condition itself makes it hard to attend appointments (e.g., severe pain, mental health crises, or mobility issues). Make sure your doctor documents these barriers in your file.

Tip: Always communicate openly with your healthcare team about any barriers to consistent medical treatment. This helps protect your claim.

How to Strengthen Your Case Through Medical Documentation

The importance of consistent medical treatment in disability cases is matched only by the need for excellent medical documentation. Here’s how to make your case as strong as possible:

Collect and Organize Everything

• Keep copies of all test results, doctor’s notes, and treatment plans.

• Ask for detailed reports from your doctor, especially about how your condition affects your ability to work.

• Document your symptoms: Keep a daily journal of how your disability impacts your life and work.

• Record missed workdays and any workplace accommodations you’ve tried.

Work With Your Doctor

• Be honest about your symptoms and challenges.

• Ask your doctor to include specific details in their notes (not just “patient is unwell,” but how and why).

• Request referrals to specialists if needed.

Prepare for Surveillance

Insurance companies may use surveillance to check if your daily activities match your reported limitations. Consistent records help protect you from unfair denials.

Sharon’s Story: Proving Consistent Medical Treatment

Sharon, in her late 40s and living in New Brunswick, developed a chronic illness that made it impossible for her to continue working. She knew the importance of consistent medical treatment in disability cases, so she:

• Scheduled regular appointments with her family doctor and followed up with specialists.

• Kept a folder with all her medical documentation, including test results, doctor’s notes, and medication lists.

• Used a journal to track her symptoms and how they affected her daily life.

• When she had to travel for a family emergency, she notified her doctor and asked for a note explaining the missed appointment.

• When her claim was initially denied for “insufficient evidence,” she worked with a disability lawyer, knowing it was her best shot at a successful claim.

Thanks to her careful record-keeping and consistent medical treatment, Sharon’s claim was settled with her lawyer, giving her the financial support she needed to focus on her health.

How Share Lawyers Can Help If Your Claim Is Denied

If your disability claim is denied, don’t give up. A disability lawyer can:

• Review your denial letter and explain the next steps.

• Help you gather missing medical documentation or arrange for new assessments.

• Communicate with your insurance company on your behalf.

• Represent you in legal proceedings, increasing your chances of success.

• We work on a contingency basis—no fees unless you win.

For more information, see our guide to proving long term disability and this video on the importance of continuing to see your doctor.

Checklist for a Strong Disability Claim

If you’re struggling with a disability and worried about your claim, you’re not alone. The process can feel overwhelming, but focusing on consistent medical treatment and keeping careful medical documentation will give you the best chance of success. If your claim is denied, reach out to a trusted disability lawyer—they’re here to help you fight for the benefits you deserve.

You deserve support—don’t face your disability claim alone. Let strong, consistent medical treatment and experienced legal help work for you.