Why Do Insurance Companies Deny Claims?

Having your disability claim denied across Canada can be a difficult and discouraging experience. After over 35 years of working with clients who have been denied by their insurance companies, we want to share some of our important insights.

Key facts about the disability insurance process

It’s important to keep in mind some key facts about the insurance process. Unfortunately, insurance companies do not want to pay out anything if they can avoid it. The reality is that they’re looking for reasons to deny claims from the beginning. They may have an easier time denying certain claims. For instance, it’s quite common for claims based on chronic pain or mental health issues to be denied or to have benefits taken away after they’ve been granted. The easy reason for this is because they’re invisible illnesses, and so the barometer for the functionality of the patient is largely subjective. It’s easier to “prove” a medical condition like a herniated disc than a diagnosis of anxiety or depression – and the insurance companies take advantage of this.

Difficulties in proving the impact of invisible disabilities

Difficulty in proving the impact of invisible disabilities like addiction raises another common reason for denial. When applying for disability benefits for addiction, it’s often required that the person be registered in a rehabilitation program of some kind or show proof of intent to register. Regardless of whether the rehab program is the right choice in a recovery journey, it’s seen as mandatory by the insurance companies, even though most rehabilitation centres are focused on complete substance abstinence rather than harm reduction. Refusal to register or a lack of enrollment is enough of a reason for insurance companies to deny the claim. This does not consider how costly some programs are, or the long waitlists that exist for the government-funded programs.

A physicians support in your LTD claim

A question we hear often from those denied their benefits across Canada is whether it makes a difference to have their physician support them in their application. As we trust our physicians with our health and wellbeing, we assume that their medical opinion is respected by the outside world. Ideally, the insurance companies would take the physician’s opinion as the truth. Unfortunately, a physician’s official diagnosis is often called into question.

The insurer is looking for holes in your disability claim

Insurance companies like to pick apart the minutia of LTD benefits claims. They’re looking for holes in your claim to find any reason to deny your claim and avoid paying out. Beyond a diagnosis and the opinion of your doctor, they’ll want to know answers to the following questions and more:

  • Why do you find yourself in this current situation?
  • What are your physical limitations?
  • What are you capable of doing?
  • How quickly can you return to work?
  • How long has the illness been going on?

In many cases, it becomes a never-ending process of questioning that often just leads to dead ends, rejection, and frustration.

Being approved your disability claim is not impossible. That’s where hiring a disability lawyer comes in. It’s our job to mitigate these questions and ensure that your insurance company doesn’t take advantage of you. Lean on us and we’ll help you through the process. At the end of the day, your well-being is our priority.

Denied your long term disability claim?

Contact 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.

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