Why Did My Long-Term Disability Claim Get Denied?

Why Did My Long-Term Disability Claim Get Denied

Why Did My Long-Term Disability Claim Get Denied?

In 2017, one in five adults had one or more disabilities. According to Statistics Canada, those individuals were much less likely to be employed. There are also cases where an injury or illness prevents you from performing your current work duties.

What is long-term disability coverage and how does it help you in this situation? This type of coverage provides a percentage of your income if you are ill or injured.

However, sometimes claims end up denied. When that happens, you should contact your long-term disability lawyer in Hamilton to figure out what you can do.

Here are seven reasons why your long-term disability claim may end up denied.


Reasons Why Long-Term Disability May Get Denied

To qualify for long-term disability benefits, a person must have a disability that prevents them from performing in their chosen occupation. Each policy has categories for “total” or “partial” disability. Evidence is required to provide coverage as well as how the disability personally affected the individual.

A long-term disability lawyer in Hamilton can help you in the case of a denial. However, it’s important to know why it might get denied in advance so you can avoid needing a lawyer in the first place.


1. Late Filing

Most long-term disability policies have a time frame for when submissions are accepted. This time frame begins from the time you’ve become disabled and can run out if you take too long. The deadline varies depending on your policy, so make sure to file as soon as possible.

In Canada, the average waiting period for your benefits to kick in is between 90 and 120 days. Even if you have a longer time frame to apply, you’ll also have to wait longer before it gets approved.


2. Lack of Proof of Disability

One of the most important parts of your disability claim is your proof. Medical documentation should include an appeal by your doctor along with medical records. You should also include an assessment of whether or not you’re capable of meeting the needs of your occupation.

Failure to provide appropriate or efficient evidence can lead to a denial. Make sure to communicate with your long-term disability lawyer if this happens to avoid another denial in the future.


3. Changes in Medical Status

Long-term disability insurance policies can payout for multiple years. While some only last for two years, others can continue well until retirement. However, it’s possible for your functional or medical status to change in that time, which can cause termination of your policy.

Additionally, the policy won’t kick in for at least 90 days. If your status changes before it’s approved, your claim may get denied.


4. Didn’t Keep in Touch with Insurer

After you’ve provided initial claim documentation, you need to keep in touch with the insurance company. Like with any application, you need to follow up.

The company may need further information, or they may want to interview you over the phone. If you ignore or fail to return their phone calls, they can use that as a reason to deny or terminate your benefits.


5. Change in Own Occupation

One of the requirements for long-term disability policies is that you’re unable to return to your previous occupation for its duration. It’s meant to help those who wish to return to work but can’t because of their disability.

If the context of your occupation changes, then you could find your claim denied or policy terminated. An example of this would be if your previous position required a lot of walking, but your company found a desk job you could do.


6. Contractual Reasons

There may be contractual reasons used by an insurance company to decline long-term disability benefits. A pre-existing condition exclusion clause could take effect if you’ve sought treatment for your disabling condition before your policy started.

Some conditions are also excluded from coverage, which may result in a denial. Drug or alcohol abuse isn’t covered. Pre-existing conditions are also excluded, though that could change if the symptoms have worsened.


7. Treatment Non-Compliance

Long-term disability policies usually come with a certain amount of requirements, such as routine medical treatment or physical therapy. If you refuse to comply with those requirements, then your benefits can get revoked.

If you’re applying for disability, the same rules apply. Your physician can’t recommend coverage or write an appeal if you don’t show up and get assessed.


How a Long-Term Disability Lawyer Can Help

You may still have questions regarding coverage. How does long-term disability work? What benefits are included?

A long-term disability lawyer should be able to help you navigate the complicated process of applying for disability. All policies are different, so it’s important to understand the exact type to apply for and its requirements.

Even though your doctor is necessary for disability applications, they aren’t legal experts. Your lawyer can work with your doctor in understanding what qualifies as a disability and how to complete the forms accurately.

In the case that your claim is denied, or your ongoing policy terminated, your personal injury lawyer can hold the insurance company responsible. Your lawyer knows what rules apply and how to best communicate with the company.


Looking for a Long-Term Disability Lawyer in Hamilton?

Applying for disability doesn’t have to be done alone. A long-term disability lawyer in Hamilton, can relieve some of the burdens and make sure you file without any errors. If there are any problems, they can also find the solution.

Virk Personal Injury Law specializes in helping victims of insurance denials. We put the needs of our clients first and are ready to help with your long-term disability claims.

If you were denied long-term disability benefits or have any other legal issues, contact Virk Personal Injury Lawyers for help.