Long-term disability insurance is a type of insurance product that is purchased to provide peace of mind for individuals so they can rest easy knowing that if they are unable to work due to a disabling medical condition, they will have the financial support they need. Unfortunately, many legitimate claims for disability benefits are denied by insurance companies, leaving individuals struggling to make ends meet.

Why Have My Disability Benefits Been Denied?

Insurance companies are businesses, and their business model works by taking in as much money as they can while paying out as little money as possible. While most people covered by a policy of insurance assume that “their” insurance company will look after their interests if they ever need to access insurance benefits, insurance companies will look for any reason they can think of to deny claims. For long-term disability claims insurance companies will often question the severity of the disability, the medical evidence provided, or allege that the claimant can perform some type of work despite their disability, regardless of whether or not your doctor supports your long-term disability claim.

Long-Term Disability Claim Denials

There are many reasons why an insurance company might deny a long-term disability claim.  Some of the most common issues that lead to long-term disability claims being denied can include:

• Lack of medical documentation: Often insurance companies will allege that you have not provided sufficient medical evidence to support your disability. The severity of your disability can lead to a denial. Usually, an insured has to pay to obtain the medical documentation themselves and may not have easy access to the clinical records of specialists they have seen relating to their disability.
• Policy Exclusions: Not all long-term disability policies are equal, and many have specific exclusions which can disentitle an individual from benefits. Often policy exclusions relate to medical investigations or conditions which pre-date coverage under the policy of insurance. Other times long-term disability policies can have specific enumerated exclusions to which the policy doesn’t apply.
• Failure to meet policy requirements: Some policies have specific criteria that must be met to qualify for benefits, such as being under the care of a licensed physician, or having your disabling medical condition diagnosed by a specialist in a specific area. There are also often requirements with respect to timelines of reporting your disability to your insurer. If you do not meet these requirements, your claim for long-term disability benefits can be denied.
• Failure to Meet the Definition: A common cause of denied long-term disability benefits is the failure to meet the definition of disabled under the terms of a policy. Often, long-term disability policies provide that for the first two years of disability, in order to meet the definition of disabled under the policy you must be unable to perform the substantial duties of your own occupation. After two years of disability, the definition of disabled often changes to being unable to perform the substantial duties of any occupation for which you are reasonably suited for. This is a higher threshold and is often used as a basis for denying ongoing long-term disability benefits after the two-year mark. Of course, every long-term disability policy can differ and it’s important to have an experienced lawyer review your specific policy to understand your rights.
• Independent medical assessments: A term that is seen in many long-term disability policies is one that allows insurance companies to require any person insured under the policy who is claiming benefits to undergo and independent medical assessments by a doctor of their choosing to see if that doctor agrees with your alleged disability. This doctor may provide opinions that conflict with your treating physician’s assessments and, in reliance on the opinion of the doctor they’ve hired, your insurance company may deny your long-term disability benefits.

This list is by no means exhaustive, and every denial of long-term disability benefits requires a careful examination of the individual insurance policy to determine the strength of the denial and the steps one should take to obtain the long-term disability benefits they are entitled to. Sometimes you can change an insurance company’s mind by negotiating with them directly, however often you will need to start a lawsuit if you want to get your insurance company to pay your long-term disability benefits once they’ve been denied.

Denied Long-Term Disability Claims & Timelines

If your long-term disability claim has been denied in British Columbia, you still have options. There is often an internal appeal process, which is often not successful as you’re appealing to the same insurer who already denied you. You can also file a lawsuit to force your insurance company to pay the long-term disability benefits to which you are entitled. There are strict timelines in which you have to bring a lawsuit for long-term disability benefits and if you fail to do so you can be statute barred, so it is always important to contact a lawyer quickly to ensure you know what your rights are.

If you have been denied your legitimate long-term disability benefits contact our experienced lawyers today for a free consultation to discuss your long-term disability claim.