What To Do When Your Long-Term Disability Claim Is Denied

Sometimes long-term disability claims are denied for reasons that are unfounded. While receiving a denial of benefits can be discouraging, it should never stop claimants from exercising their right to appeal the decision and request that their claim be re-examined. Though this may sound pretty straightforward, the appeals process is complex and difficult to navigate and can often result in a continued denial.  The reason for this is quite simple – nothing has changed since the original denial and since the insurer never provides claimants with the tools to resolve the issue(s) that caused their denial in the first place, it is difficult to have a successful appeal.   Accordingly, a lawsuit is generally the only way to obtain the benefits that you are legally entitled.

Reasons Your Long-Term Disability Claim May Be Denied

One of the most common reasons disability claims are denied is that the mental or physical conditions documented in the appeal do not meet the insurer’s definition of disability. To qualify as disabled, your health condition must impair you from performing most or all of the requirements of your current job. In general, after receiving benefits for 104 weeks, you must also prove that you are unable to perform any other job for which you are qualified.

Some disability policies include specific definitions of disability and impairment, including requirements for how long a condition must have lasted or is expected to last to qualify as a disability. Failure to meet these definitions or durations of illness may result in the denial of your claim.

Other reasons claims are denied include failure to respond to insurance company requests for medical examinations, documentation or information. If your insurer requires a medical examination to verify your condition and its severity, you should attend the consultation as soon as possible. Make sure you respond to all requests for documents, information and evidence as required by your policy no matter how stressful these requests can be.

Steps to Take if Your Long-Term Disability Claim is Denied

The first thing you should do upon receiving a notice of denial is to contact a disability lawyer. After the appeal process fails, you will be forced to commence a lawsuit against the insurance company for breach of contract, which may ultimately result in a trial, if necessary, to seek the full amount of benefits to which you are entitled. The litigation process is not one that you want to undergo without the help of a legal professional.  With the help of an experienced lawyer, many of these claims can be successfully settled without the need of a trial.

If your claim was denied because the terms of your policy weren’t met or because your insurer believes you are capable of continuing your current work or other qualified employment despite your condition, you should strongly consider filing a lawsuit against your insurer. To begin a lawsuit, a Statement of Claim has to be filed.  However, in order to be successful, you must produce additional evidence, such as statements of job performance from your employer or new evaluations from medical specialists and vocational experts.

Although you can request an explanation of why your long-term disability claim was denied, some insurance providers are not required to comply. If this is the case, a lawyer can review the terms of your policy and compare them to the documents you originally submitted with your claim. He or she can then determine if further evidence is needed to support your claim. In some cases, it may be a simple mistake on your application that resulted in a denial, and resubmission of the application may be enough to correct the situation.

A disability lawyer can assist you in understanding the grounds upon which your claim was denied and how to go about continuing to pursue long-term disability benefits.

Contact a Disability Lawyer If Your Long-Term Disability Claim Is Denied

Obtaining a favorable decision for your disability claim on the first attempt is not as easy as it may seem. Simple errors on your application or a lack of evidence can cause the insurance company to deny your claim for benefits. Some insurance companies may even deny claims to avoid paying claimants the benefits they are entitled to.

Preszler Law Firm wants to ensure this doesn’t happen to you. We help residents of Ontario secure the disability benefits that their long-term disability policy grants. Contact our office today to schedule a free, no-obligation appointment to discuss your case and determine your options: 1-800-JUSTICE®.  And remember, there is a never a fee unless we recover money for you.

Common Disabilities