long term disability Ontario
long term disability

Denied Long-Term Disability Claims: Reasons & Appeals

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When you’re unable to work due to a severe injury or illness, you often worry about your financial condition. But do you know long-term disability insurance can provide you with financial assistance? However, sometimes, your insurance company denies claims. Though there are many reasons for the denial, with the help of legal assistance, you can appeal for the denied case. Here, we will explore some of the most common reasons for long-term disability claim denials and provide tips on how to appeal a decision.

Reasons for Long-Term Disability Claim Denials

Insufficient Medical Evidence

Your insurance company needs comprehensive documentation from medical professionals. It gives them complete information on diagnosis, symptoms, and treatment plans. But the claim may be denied if your medical records do not support your inability to work.

To avoid this type of denial, it’s crucial to keep detailed records of all medical meetings and treatments related to the disability. Ensure you request copies of all medical records and keep them safe. It’s also vital to keep communication regular with medical professionals and keep them informed of any changes in symptoms or treatment.

Lack of Proof of Income

When applying for a long-term disability claim in Ontario, keep the details of your previous income before you had the disability. Your insurance companies need them to determine the amount of benefits to provide. In the absence of it, the claim may be denied.

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Avoid denial by keeping detailed income records, such as tax returns and bank statements. It’s also essential to notify the insurance company of any changes in income, such as bonuses or overtime.

Pre-Existing Conditions

If you have any pre-existing condition that is the primary cause of the disability, there are chances of receiving a denial. However, insurance companies must provide coverage for disabilities caused by pre-existing conditions if the claimant has been covered by the policy for a certain period.

So, reviewing the policy’s pre-existing condition provisions before filing a claim is crucial to eliminate any chances of denial. It’s also important to disclose any pre-existing conditions when applying for coverage.

Appealing Denied Claims

If, for any reason, your claim has been denied, carefully review your denial letter to understand the detailed explanation of why the claim was denied.

After reviewing the denial letter, you can proceed with the following steps:

Gather Additional Evidence

If the reason for the denial was insufficient medical evidence, gather more information from your medical professionals to support your claim.

Seek Legal Assistance

If the denial was due to pre-existing conditions or other complex issues, you might need the assistance of a legal professional experienced in long-term disability claims.

Follow the Appeals Process

Once you have all the supporting documents, you can submit an appeal to the insurance company. It’s vital to follow the appeal process outlined in the policy, as failure to do so may result in a loss of benefits. Make sure you meet all deadlines and provide all required documentation.

File a Lawsuit

If the appeal process fails, you can even file a lawsuit against the insurance company. It’s essential to consult with an attorney experienced in long-term disability claims before pursuing legal action.

If a claim is rejected, reviewing the denial letter carefully and following the appeal process outlined in the policy is necessary. With patience, persistence, and experienced legal guidance, you will receive the rightfully deserved benefits.

 

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