You’re probably 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, we will discuss a few of the most common.
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 it is mandated by the applicable insurance legislation.
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 an experienced disability lawyer review your situation to see if there is any chance of avoiding the Pre-Ex clause.
Incomplete Claim Forms
A response from the insurer that they are unable to make a final decision because information is missing from what has been submitted, is obviously very frustrating and hard to see as anything other than a delaying tactic.
If this is the reason for the denial or “non-decision”, the first thing to check is whether there is something that can be done to provide the missing or erroneous 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 not necessarily included in the initial forms, such as copies of health care providers clinical notes and records, medical test results, financial information, and the list goes on…
In many cases, it is hard to feel like there is no way to ever provide all of 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 a disability insurance lawyer about whether the ongoing 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
We see this reason with great frequency and it is probably the most frustrating one for claimants because, what they’re really saying is that they are not satisfied that whatever you are suffering with 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 our experience, your doctors are probably as frustrated as you are in understanding what else they can provide that would substantiate the reasons for not being able to work. In many cases, if you go back to your doctor and ask them for more assistance, they may say, what else is there for me to say.
If you have supportive health care providers and you are unable to work due to a medical condition, a letter like this is when you should be contacting an experienced disability insurance lawyer for assistance.
Has your long-term disability claim been denied? Contact Share Lawyers and put our experience to work for you. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.
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A note from our long term disability lawyers
Taking a medical leave from work is not an easy decision to make. Concerns about providing for yourself and your family and keeping your job may cause you to want to push through your pain, but this won’t make your problems go away. Stopping work is often the smartest decision for your long term health and well-being, and your disability benefits are there to provide you with financial support until you can return to work.
If you have made the tough decision to stop working and apply for your short term disability or long term disability benefits, you may feel overwhelmed by the process and have questions that your employer and your insurance company are not able or willing to answer. Share is There to see you through and answer your questions.
Our Disability law firm knows what you have been going through
We understand that things have not been easy for you over the last little while. Your health has been suffering, you are unable to work, and now your insurance company, who was supposed to be there in your time of need, has decided they will not pay your disability benefits or respect your disability claim. These benefits exist to provide you with the financial support you need so that you can focus on your health and rebuilding your life. It is unfortunate that your insurance company has not lived up to its promise. If your disability claim has been denied, we will fight to get you the benefits you are entitled to. Our disability lawyers have helped thousands of Canadians get their long term disability benefits over the past 35 years, and we can help you too.
Our experienced disability lawyers can fight back on your behalf
Share Lawyers believes that every client who is dealing with a disability claim deserves superior personal service. To achieve that goal, we have developed our team of experienced, compassionate, and caring long term disability lawyers, law clerks, and administrative staff to meet all of your needs. Our team of experienced long term disability, life insurance, employment, and critical illness insurance lawyers have made successful claims against many insurance companies, third-party administrators and employers.
If you are unable to work, your disability benefits should be there to provide you with the financial support you need. While your insurance company may be focused on finding ways to avoid paying your claim, our focus is on what is in your best interest. When Share Lawyers gets involved, you have an entire team of lawyers that are there to support you and to fight for what is yours.
Our disability claim lawyers fight for your disability insurance claim by relying on our many years of experience to apply the best strategic planning and approach in each case, using the latest technology available. Experience matters, and with Share Lawyers, you are in the best hands with 35 years of success on your side.
In this video, we explain the role of a long term disability lawyer and how we can support you when you have been denied your long term disability benefits.