Has your insurer denied your claim for long-term disability benefits, despite you faithfully paying your premiums? Below are four things you must know if you’ve been denied benefits.
1. Your Initial Claim May Have Lacked the Correct Information
Long-term disability insurance providers may deny an otherwise qualified claim based on lack of evidence. For instance, your initial claim may have lacked substantial proof of your injuries or crucial details about your work history and the nature of your job.
Evidence necessary for a long-term disability claim includes (but is not limited to):

  • medical records (including diagnosis of injury, treatment and long-term prognosis);
  • employment information (including proof of employment, work history and income); and
  • information about your job (including a detailed description – as provided by a supervisor or employer – of your job and the tasks involved.)

A long-term disability lawyer can review your initial claim to determine whether it lacked necessary information. Once you understand the shortcomings of your claim, you can move forward in building a strong appeal for benefits.
2. You May Have Been the Victim of Unfair Treatment by Your Insurer
Do not assume the insurance company was correct in denying your claim. An insurance company is, first and foremost, a business. Adjusters and other employees are concerned most with protecting the company’s bottom line. Insurance companies have been known to employ deceptive or otherwise unfair tactics in efforts to minimize or deny long-term disability benefits.
Examples of unfair treatment may include:

  • failure to disclose the terms of a policy;
  • terminating a policy without notice or cause;
  • changing policy guidelines or disability requirements; and
  • claiming you do not meet policy standards for disability.

Proceed with caution if you suspect you were the victim of unfair treatment. Maintain records of all communication with the insurance company and be careful in what you say to company representatives. Do not become argumentative or level accusations against the company. Instead, ask a disability lawyer to assess the details of your claim.

3. The Insurance Company’s Denial Does Not Have to Be the Final Word
Ask for a verbal explanation of the denial preferably from a supervisor. Next, ask for the decision in writing. A lawyer can evaluate the explanation you receive from the insurer. This provides you with important information should you choose to appeal or litigate the insurer’s decision.
4. You Have the Right to Hire a Lawyer to Help You with Your Claim
You are not obligated to hire a disability lawyer to help you with your appeal, but you do have the right to work with a lawyer in pursuit of benefits. Ask a potential lawyer for details about his or her experience handling cases similar to your own before hiring. Also ensure you receive a written copy of his or her fee structure.
Don’t let the insurance company take advantage of your situation. Call 1-800-JUSTICE® to schedule a free, no-obligation case evaluation with the Preszler Law Firm in Ontario.