Insurance companies like Sun Life, Manulife and Canada Life, along with many others operate under a business model that prioritizes profits over approving claims. This is one of the major reasons why so many long term disability claims are denied.
This model involves underwriting risk (placing a dollar value on your risk of becoming disabled and filing a claim), taking in premium dollars from its policyholders (you or your employer), investing those dollars, and, when necessary, paying out on claims made on its policies. So, what does this mean? For these insurance companies to prosper, or even stay in business, it must maximize premium dollars and return on investments while minimizing the cost of claims.
Insurance companies operate in highly competitive markets, and it is not uncommon for them to pull out of an unsustainable or unprofitable market. In essence, insurance companies cannot make a loss for any considerable length of time. They vigorously manage their claims process and pay out on as few claims as possible. Insurance fraud does occur and so, understandably, insurance companies wish to protect themselves as much as possible against it.
To control claims and combat fraud, insurance companies like Sun Life, Manulife and Canada Life operate defensively, with a strategy to deny claims wherever possible. Policies are written with clauses, sub clauses, limitations, and exceptions. When the terms of a policy are ambiguous, they will inevitably err on the side of the insurance company.
Claims analysts or claim managers are responsible for verifying the validity and acceptability of claims. These professionals are trained to control claims. A claims adjuster who is paying out on too many claims is simply not performing and could jeopardize his or her job. Insurance companies carefully guard their training practices to avoid the appearance of training their staff to deny claims, but reviewing case files demonstrate the methods insurance companies use to encourage claims to be denied.
To combat fraud, insurance companies routinely hire investigators to monitor disability claimants, which can include physically following them during their daily activities. The result of this surveillance can be used to make cursory decisions on whether the claimant could perform their job if they were back at work. They also hire their own medical consultants to conduct paper reviews or independent medical examinations to improve their chances of obtaining a medical evaluation in their favour, one that ultimately means your claim may be denied.
The result of this vigorous defense of claims is that processing of disability claims can be unduly lengthy, complicated, and overly burdensome on individuals who may be already overwhelmed by daily activities in the face of an injury or major illness. Efforts to control claims and combat fraud have created overwhelming amounts of paperwork, requests for information, delays, and unfair denials.
The defensive tactics of the insurance company have created an uneven playing field, in which the average claimant, inexperienced in the process of filing a disability claim, is pitted against a powerhouse opponent. These tactics have the potential to create an adversarial relationship and can lead to frustration and aggravation, exacerbating an already difficult time.
Call Share Lawyers - We Can Help
If you are struggling with a disability and you have had a long term disability benefits claim denied by your insurance company, you deserve to be heard and you should fight for your rights. Call Share Lawyers and we will help you get the long term disability benefits you deserve. The disability lawyers at our disability law firm have the experience to help you get the benefits that you need. We offer a free consultation so that you can find out your options.