You might be reading this blog because you have been denied your disability insurance benefits, and are feeling frustrated, angry, hopeless, and don’t know what to do. There are a number of reasons why disability claims get denied. In this blog, our experienced lawyers for long term disability will discuss a few of the most common reasons.
The pre-existing exclusion clause ("Pre-Ex")
Group Disability Insurance benefits (benefits provided through a group policy through your workplace) usually contain a pre-existing exclusion clause for long term disability benefits. This clause does not usually apply to entitlement to short term disability benefits, so you may have received those, but may have been denied because of the Pre-Ex clause In short, this clause allows your claim to be denied if you have only had coverage for a short period of time (usually less than one year) and have been suffering with the same medical condition in the past during a period that will mean that you cannot obtain your LTD benefits. This clause is included to protect the insurance company from having to provide benefits to individuals they would not otherwise have ever insured had medical disclosure occurred at the time you were hired. It may seem unfair, but the applicable insurance legislation mandates it.
In some cases, there may be a way around it, but this requires review and examination by an expert in disability insurance. Before you give up, it may make sense to have experienced lawyers for long term disability review your situation to see if there is any chance of avoiding the Pre-Ex clause.
Incomplete claim forms
It's very frustrating to receive a response from the insurance company explaining that they are unable to make a final decision because information is missing from your application. It's hard to see this response as anything other than a delaying tactic.
If this is the reason for your denial or “non-decision”, the first thing lawyers for long term disability suggest is to check is whether there is something that can be done to provide the missing information. It is important to complete these forms as completely and accurately as possible to avoid this type of response.
In some cases, the request is for additional information is not included in the initial forms, such as copies of health care providers' clinical notes and records, medical test results, or financial information.
In many cases, it may seem impossible to feel like you could provide all the information the insurance company says they need to make a decision. If you fall into that category, it may be time to consult with lawyers for long term disability about whether the the requests for information are reasonable, or they are just delaying the inevitable decision to deny your claim outright.
Your claim has been denied due to insufficient medical evidence
Our lawyers for long term disability see this reason a lot. It is probably the most frustrating response to get, because what they’re really saying is that they are not satisfied that your medical condition is serious enough to prevent you from going to work. It could be that your medical information is not emphatic enough about the reasons you cannot work, but in the experience of our lawyers for long term disability, your doctors are probably as frustrated as you are in understanding what else they can provide. In many cases, if you go back to your doctor and ask them for more assistance, they may not know what else to provide to you.
If you receive any of these responses denying your long term disability claim, contact our lawyers for long term disability immediately. We've been working in disability law for over 35 years, have helped over 8,000 Canadians get the disability benefits they deserve, and know how to help you.
Denied your long term disability claim?
Contact the lawyers for long term disability at Share Lawyers today and put our experience to 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. We offer free consultations and there are no fees unless you win your case. Join us on Facebook and become a Top Fan for a chance to win each month.