Denied LTD Benefits Despite Chronic Pain Diagnosis

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The realities of long term disability insurance

Disability insurance is a benefit that few of us hope ever to use. In reality, however, many of us do. In fact, one in three people will experience disabling medical symptoms for 90 days or longer at least once before age 65. Circumstances, an illness, or an accident may leave us unable to work. It can be a very stressful time - our disability law firm knows this well.

Long term disability insurance is an important safety net offered by an insurance company, one that should provide peace of mind. It provides financial support for an employee when that employee can no longer work. A self-employed businessperson or professional will often purchase a private disability policy that will pay them a disability claim if they can no longer work.

Let down by the insurance company? You're not alone

Many people put a lot of faith in their disability insurance and disability claims, believing it will be there for them should the unexpected happen - the diagnosis of a new or worsening medical condition. You have been paying a portion of your salary to these benefits and they are being set aside for this purpose. Yet, as you may have already discovered, the road to a successful disability claim can be long and arduous and can often lead nowhere.

If you are reading this blog, chances are you may have received a denied disability claim. You may be unsure of your options and confused about what steps to take next. You may also find the process daunting. You may even feel jaded, perhaps ready to concede defeat. Don't give up! There are options available to you. A long term disability lawyer at Share Lawyers can meet with you for free to discuss your options.

We wanted to share a real client story with you to illustrate our point. Please note that all names and identifying details have been changed to protect the confidentiality of all involved.

Alessandro developed a medical condition with disabling symptoms

Alessandro is a 41-year-old tailor who worked at his family’s business - a high-end suit shop - ever since he was a teenager. As soon as he graduated high school, he began to work full-time at the shop. Chronic pain is not something he ever thought he would have to deal with.

After a few years, the shop was bought out by a larger company, but the new owners happily kept Alessandro as an employee. He had the right amount of passion and a good reputation with a lot of local clients.

The pain begins

Throughout many years of intricate and exhausting handiwork, Alessandro experienced bouts of carpal tunnel syndrome, but his symptoms were usually manageable after a day or two with a brace around his wrist and some icing in the evenings. Eventually, the pain wasn’t just in Alessandro’s hands; he started to have consistent pain in his elbows and lower back. As he got older, the numbness and pain didn’t go away as fast as it did in the past.

It got to the point where Alessandro was in pain every day. The pain was affecting his work and his home life - his girlfriend could always tell when the pain was bad, as Alessandro would lose his patience easily and experience severely low energy after work.

Diagnosed with chronic pain

Alessandro finally went to his doctor. After Alessandro admitted to years of trying to manage his pain himself, his doctor diagnosed him with chronic pain. The pain medication he was prescribed didn’t seem to help. Alessandro was referred to many different specialists to figure out methods of pain management - from physiotherapy to massage, to pain injections and acupuncture, but none of them helped. And although all their methods were different, all specialists advised the same thing: he shouldn’t be working. As much as Alessandro wanted to be at the shop, he decided that he should focus on managing the pain and stopped working. He received EI sick benefits for 15 weeks and then applied for long term disability benefits by filing a long term disability claim.

Alessandro's disability claim was denied by his insurance company

When Alessandro finally heard back from his insurance company, he was shocked that his claim was denied. The insurance company believed that Alessandro could find another job. Being a tailor was the only job that Alessandro had ever had - and he wasn’t healthy enough to start from scratch in a new profession. In his circumstances, he wouldn’t be able to find a job that paid as well as custom tailoring. The chronic pain wasn’t the only thing affecting his sleep anymore - he lay awake many nights not only from pain, but trying to figure out a way to get some form of income. After another specialist diagnosed him with generalized anxiety, he felt like he was at his limit.

During one of his late nights, he was searching online for disability lawyers when happened to click onto the Share Lawyers website. After reading many of the testimonials on their blog, he felt inspired to reach out and called them the next morning. A few days later, Alessandro met with Samantha Share, a long term disability lawyer, and he felt at ease and that finally there was a person and a team determined to give him the help he needed.

A disability lawyer negotiated a settlement

After collectively working with Alessandro’s many medical specialists, the disability lawyers at Share Lawyers were able to negotiate a settlement during mediation. That mediation resulted in him being paid him all the money that they owed and future benefits. Alessandro was overwhelmed with relief, and pleased that he had contacted Share Lawyers. He was able to continue seeking the physical and mental help that he needed, without worrying about the financial implications.

Why was chronic pain denied for long term disability benefits?

There are several common reasons why disability claims are denied that have very little to do with your diagnosis.

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 disability claims 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 and disability claims - a long term disability lawyer. 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 long term disability claim forms

A response from the insurer that they are unable to make a final decision because information is missing from your disability claim application 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 disability 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.

What to do if you've been denied LTD benefits

If you have been denied your long term disability benefits, watch the video above with information from our disability law firm to learn why you should fight back against the insurance company with our help. If you're not yet ready to talk to our legal team, you can read more information on the Denied Disability page on our website.

Denied your long term disability claim?

Contact disability law firm 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. Our disability law firm offers a free consultation and there are no fees unless you win your long term disability claim. Join us on Facebook and become a Top Fan for a chance to win each month.