Having your disability benefits denied or terminated can be a critically difficult time. Not only are you already suffering from reduced or no income – but you now have to deal with consulting a long-term disability lawyer about your situation. In our experience, there are several reasons why long-term disability benefits can be denied at the application stage, at the change of definition (2 year mark) or at any point later in the claim. Understanding these reasons can help you navigate the disability claims process better and also help you with formulating your questions when you meet with one of our disability lawyers.
Our Ontario Disability Lawyers will likely tell you that most long-term disability carriers in Canada have provisions in their policies which state that you must be under qualified treatment. For example, many Manulife policies state that “you must be under the care of a qualified doctor” or “you must follow medical treatment deemed appropriate for your illness or injury by Manulife.” Canada Life has policies which often state that no benefits are payable if you fail to participate or cooperate in a prescribed plan of medical treatment appropriate for your condition” or that long-term disability benefits will be terminated if you fail to participate or cooperate in an approved rehabilitation plan or a medical or vocational assessment.
Therefore you cannot expect to not mitigate your conditions and receive disability benefits. You must always be trying to make yourself better in one way or another. If you do not follow a prescribed treatment plan, medical advice or therapies that could improve your condition, the insurer might see this as a reason to deny or terminate benefits.
Digital investigation is an inexpensive avenue to gather information of claimants and what they are up to. By investigating a your social media profiles, disability insurance companies can obtain firsthand insight into the your daily activities, social interactions, and even your physical capabilities, which might contradict the limitations stated in your medical productions.
This method of investigation is relatively cheap when compared to traditional surveillance methods like hiring private investigators. Moreover, some investigators might employ more covert tactics, such as sending friend requests to your family or close friends, to gain access to restricted posts and photos. This indirect approach can allow insurers to observe your without arousing any suspicion, making it a compelling method for them to use. As a result, our clients are often advised to be cautious with their social media activity and privacy settings if they are pursuing legal action against their disability insurance company.
One of the most common reasons for denial or benefit termination which our long-term disability lawyers have seen is because of the lack of comprehensive medical documentation to support your claim. The insurer will typically want to see consistent and detailed records that demonstrate the severity and duration of the disability. Remember – you have the burden of proving your disability. No matter if your claim is for depression, anxiety breast cancer, or other related issues – you need to produce medical evidence to justify why you cannot work.
It can be quite confusing when your disability claims adjuster says that he/she believes you can work or that the disability insurance company doctor says you are “not disabled.” It can be quite confusing since in most cases – your adjuster and the disability insurance company doctors will “over-ride” your own doctor’s recommendations or clinical opinion.
The problem is when a disability insurance company’s in-house doctor reviews your medical file, potential biases can arise which can cast doubt on the impartiality of the assessment. The obvious concern is the inherent financial relationship: the doctor is compensated by the insurance company, and there might be conscious or unconscious pressure to produce reports that align with the company’s financial interests.
This dynamic could unintentionally favor determinations that reduce long-term disability claim payouts, such as concluding that “you can work”.
Even worse is the issue of specialization; a general physician or a doctor from another specialty might not fully grasp the nuances of specific conditions such as the complexities of auto-immune disorders or the psychological impact of a woman suffering from breast cancer, then undergoing a mastectomy.
Additionally, doctors who exclusively review your medical productions rather than physically examining you might lack a comprehensive understanding of your real-time health condition. While it may be the case that many in-house doctors strive for fairness, the ties between their employment and the insurance company’s financial outcomes can create situations vulnerable to bias. Contact our Disability Lawyers if this has happened to you.
Many LTD policies have clauses that exclude coverage for conditions that were present or diagnosed before the policy was in effect.
What is a pre-existing condition? A pre-existing condition is typically defined as any injury, illness, or medical condition for which you sought treatment, took medication, or received medical advice within a certain period (e.g., 12 months) before the policy came into effect.
The way this works is that if you become disabled within a specified time after the policy takes effect (e.g., within the first 12 or 24 months), the insurance company will scrutinize your medical history from the period before the policy started (e.g., the 12 months prior). If the disability is deemed to be related to a pre-existing condition that was treated or diagnosed in that look-back period, your claim can be denied.
If your disability claim has been denied for any of these 5 reasons – or for any other reason – call us today. Our long-term disability lawyers have recovered tens of millions in wrongfully denied long-term disability benefits for residents in Ontario and throughout Canada.
Contact us today no matter where you are in Canada by calling us at 1-844-4-DISABILITY. Alternatively you can email us confidentially and our intake specialist will help you set up an appointment in-person, by phone or by virtual video conference. Our Ontario Disability Lawyers are based in Hamilton and serve disability claimants all across Canada.