Insurance companies like Sun Life, Manulife and Canada Life, along with many others operate under a business model that prioritizes profits over approving claims. This is one of the major reasons why so many long term disability claims are denied.
This model involves underwriting risk (placing a dollar value on your risk of becoming disabled and filing a claim), taking in premium dollars from its policyholders (you or your employer), investing those dollars, and, when necessary, paying out on claims made on its policies. So, what does this mean? For these insurance companies to prosper, or even stay in business, it must maximize premium dollars and return on investments while minimizing the cost of claims.
Insurance companies operate in highly competitive markets, and it is not uncommon for them to pull out of an unsustainable or unprofitable market. In essence, insurance companies cannot make a loss for any considerable length of time. They vigorously manage their claims process and pay out on as few claims as possible. Insurance fraud does occur and so, understandably, insurance companies wish to protect themselves as much as possible against it.
To control claims and combat fraud, insurance companies like Sun Life, Manulife and Canada Life operate defensively, with a strategy to deny claims wherever possible. Policies are written with clauses, sub clauses, limitations, and exceptions. When the terms of a policy are ambiguous, they will inevitably err on the side of the insurance company.
Claims analysts or claim managers are responsible for verifying the validity and acceptability of claims. These professionals are trained to control claims. A claims adjuster who is paying out on too many claims is simply not performing and could jeopardize his or her job. Insurance companies carefully guard their training practices to avoid the appearance of training their staff to deny claims, but reviewing case files demonstrate the methods insurance companies use to encourage claims to be denied.
To combat fraud, insurance companies routinely hire investigators to monitor disability claimants, which can include physically following them during their daily activities. The result of this surveillance can be used to make cursory decisions on whether the claimant could perform their job if they were back at work. They also hire their own medical consultants to conduct paper reviews or independent medical examinations to improve their chances of obtaining a medical evaluation in their favour, one that ultimately means your claim may be denied.
The result of this vigorous defense of claims is that processing of disability claims can be unduly lengthy, complicated, and overly burdensome on individuals who may be already overwhelmed by daily activities in the face of an injury or major illness. Efforts to control claims and combat fraud have created overwhelming amounts of paperwork, requests for information, delays, and unfair denials.
The defensive tactics of the insurance company have created an uneven playing field, in which the average claimant, inexperienced in the process of filing a disability claim, is pitted against a powerhouse opponent. These tactics have the potential to create an adversarial relationship and can lead to frustration and aggravation, exacerbating an already difficult time.
Call Share Lawyers - We Can Help
If you are struggling with a disability and you have had a long term disability benefits claim denied by your insurance company, you deserve to be heard and you should fight for your rights. Call Share Lawyers and we will help you get the long term disability benefits you deserve. The disability lawyers at our disability law firm have the experience to help you get the benefits that you need. We offer a free consultation so that you can find out your options.
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.