Why do Long-Term Disability Claims Get Denied in Ontario?

What the Insurance Companies Don’t Tell You and How You Can Be a Savvy Policy Holder

Disability insurance companies are notorious for denying coverage for reasons that seem unfair. If you have an illness or injury that prevents you from making a living, you should be able to rely on disability insurance benefits.

“Insurance companies do not tell you that their job is to look for any and every way to not pay benefits,” said Samantha Share, Assistant Managing Director at Share Lawyers. Unfortunately, often claimants will not challenge a disability insurance denial because they are intimidated and believe that the little guy has no chance of winning against a disability insurance giant.

However, armed with the right information and preparation you can successfully challenge disability claim denials. Here are the primary reasons why disability claims are denied in Ontario, and why you should dispute them.

Inadequate Medical Evidence

The insurance company claims the diagnostic documentation or the doctor’s evaluation of your inability to work is not persuasive enough. This is a common stalling tactic. Share said, “Insurance companies can use tactics such as referral to an independent medical evaluation or rehabilitation services to gather more information in order to delay paying benefits.”

If you’re given this reason, consider calling a disability lawyer or use this free online tool to determine how an experienced disability lawyer can help because challenging a denied disability claim balances the playing field.

Pre-Existing Exclusion Clause

Under Ontario legislation, an insurance company is protected from having to provide benefits to individuals who would have never been insured had the medical condition been previously disclosed. However, these clauses are often open to interpretation and an experienced disability lawyer may be able to determine that the insurer’s timeline analysis is not valid or that the claim is based on a new medical condition that would not be caught by the pre-existing exclusion clause.

Determination of “Total Disability”

If your illness or injury prevents you from performing the main duties of your “own occupation”, you may qualify for disability benefits. After 12-24 months, a medical consultant will determine if you can transition into “any occupation” coverage. Often insurance companies will say that while they accept that you cannot do your own job, that you should be able to do something, which leads you to believe you need to be suffering a catastrophic illness or injury. But this is the furthest thing from the truth. To consider whether you can overcome this termination of disability benefits you should consult an experienced disability lawyer.

You’re Under Surveillance

Often insurance companies will use private investigators to follow people in their everyday lives. The whole idea of being tailed by a stranger who is hunting for a “gotcha” moment can be distressing. Unless you’re lying about your injury or illness, there is nothing to worry about.

Their Medical Expert Contradicts Your Doctor

Their medical doctor doesn’t think you’re disabled. Who will a judge believe, an insurance consultant who has undertaken a brief assessment of your condition, or your own doctor who has cared for you for years? Share said, “They often will refer to an in-house medical consultant on which to base their decision not to pay benefits.”

What is Your Next Step?

Claimants who have been denied disability benefits should use one of the free online tools available to find out if they have a valid disability case and not wait to call a disability lawyer. The longer they wait, the longer they will be without income. Samantha Share said, “A disability lawyer can get the appeal or lawsuit process started right away. They also can make suggestions as to alternate forms of income that may be available to the claimant during the waiting period.”

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.


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.

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