Exaggerating Symptoms Can Result in a Denied Disability Claim
You have a medical condition that is legitimately disabling and you're preparing a disability claim to submit to your insurance company.
A lot is riding on this: your health, your finances, your future as you know it. You've heard insurance companies have high denial rates for long term disability claims (hovering around 60%) and worry they will deny your LTD claim like they have so many others.
Why are long term disability claims denied?
There are several common reasons why disability claims are denied by the disability insurance company. Some of the most common reasons are:
Filing a claim or appeal late: Policies from disability insurance providers often stipulate a timeline under which to submit a long term disability claim, beginning from the point you first became disabled, but this timeline isn’t always clear.
You are not “totally disabled”: Insurance companies use the term “totally disabled” because they want you to believe that you need to be paralyzed or in a coma to qualify for long-term disability. “Totally disabled” means that a doctor has confirmed that you’re unable to perform the essential aspects of your own job.
Insufficient medical evidence: The disability insurance company may not accept your doctor’s assessment of your disability, especially in cases where your condition cannot be verified through medical evidence such as diagnostic imaging or a blood test. This is often the case with mental health claims and chronic pain disability claims, that cannot be proven through testing.
Your medical condition is contested by the insurer: An internal medical consultant may review your long term disability claim application and report that your condition is not severe enough to meet the disability insurance benefits criteria.
Pre-existing condition: One of the most common reasons for rejecting a disability claim is the pre-existing condition exclusion clause. If the insurance company determines that you sought treatment before your disability insurance policy took effect, your long term disability claim may be denied.
Why exaggerating your symptoms can cause a denial of long term disability benefits
Applying for disability benefits can be intimidating, especially knowing how often insurance companies unfairly deny legitimate disability claims. Because of this, it might feel tempting to do everything in your power to submit the best claim possible - one that they could never turn down. We’ve heard it from many clients over the past 35 years of working in long term disability law: some people feel like they could exaggerate their symptoms, thinking that it might give them an extra chance of receiving their long term disability benefits. However, it's important to remember that if the insurance company finds out that any information in your application is untrue, your claim will be immediately dismissed with little chance of appeal or working with our long term disability lawyers to fight back and get what is owed to you.
Your insurance company’s claims adjuster has years of experience handling disability claims. They are eager to weed out what they consider to be "invalid" claims. Don't attempt to outsmart the powerful insurance company - it’s a losing game. Instead, arm yourself with legitimate proof to support your claim. Don't allow feelings of fear and intimidation to get the best of you. Stand behind everything you claim in your disability benefits application.
In addition to this, if you have applied for long term disability benefits, your insurance company may be watching you.
As we’ve discussed many times, surveillance is standard practice for insurance companies, as their ultimate goal is to deny your claim or terminate your existing benefits. To build a case against you, the insurance company will often check in on you to ensure that you’re not lying or exaggerating your insurance claim.
Follow the rules to avoid a denied disability claim from the insurance company
Though it may seem tempting to exaggerate your symptoms, it’s not worth the risk. You have a valid claim if:
You have strong support from your medical doctors validating that your disability prevents you from working
You have followed the claims submission process as outlined in your insurance policy
What is in your power is to present the facts and hope that your insurer lives up to their end of the bargain.
If you do receive a denial, that's when you need to hire a lawyer experienced in the area of disability law to fight for your benefits on your behalf. Be proud of yourself for being honest and following the rules. Remember, that with our help, you will get what is rightfully yours. Contact us today for a free consultation.
If your disability claim has been denied but you’re not ready to talk to anyone, you can read more on our Denied Disability Benefits page.
Denied your long term disability claim?
Contact the 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 case. Join us on Facebook and become a Top Fan for a chance to win each month.
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 an LTD lawyer and how we can support you when you have been denied your long term disability benefits.