Denied Long-term Disability Benefits? Find Out Why

  Published on November 13, 2017  

Long-term disability (LTD) coverage exists to provide security in the form of income replacement, in the event that you become ill or injured and are not able to work. Many people are covered for LTD under their employer’s group insurance plan, but you may also independently purchase LTD coverage from an insurance company.

Whether you have individual or group coverage, you are generally eligible for LTD benefits within the first two years after becoming disabled, if you can provide medical evidence showing that you are unable to perform the required duties of the job you had prior to your injury or illness.  After two years, in order to be eligible for LTD benefits, you need to provide evidence that you cannot perform the required duties of any job for which you are reasonably qualified, by reason of education, training or experience.

It is unfortunately not uncommon for insurers to deny LTD benefit for claimants who are legitimately disabled by illness or injury, according to the requirements of their LTD policy.  When this occurs, your best recourse is to speak with an experienced disability benefits lawyer at Stevenson Whelton MacDonald & Swan, who well understands the requirements and legalities pertaining to LTD claims.

After being denied benefits, claimants have the option to appeal the decision via the insurance company’s appeal process, which generally involves providing additional medical reports and/or submitting to an assessment by the insurer’s physician.  While this may appear to be a logical step after LTD benefits are denied, it can be a prolonged and tiring process and often leads to further denial of a claim.  For these reasons, you are well advised to consult with a lawyer to find out if litigation against the insurer is your most effective course of action.

The most common reasons for denial of LTD benefits

  1. The application failed to prove that you meet the eligibility requirements; for example, if your doctor did not fully explain how your symptoms prevent you from performing the essential tasks involved in your work (or any occupation, after 2 years).
  2. Too late – The application missed the contractual limitation period (i.e. deadline) for making an LTD claim.
  3. Insufficient objective medical evidence, such as professional psychological assessments, X-ray reports and laboratory test reports.
  4. Pre-existing condition – This generally does not apply to work group policies; but in the case of individual plans, the insurer may allege that your disability arose from a pre-existing condition which is an excluding condition in the LTD policy.
  5. Excluding condition – Drug and/or alcohol addiction are other excluding conditions in many LTD policies which may preclude an applicant from being eligible for benefits.
  6. Failure to follow your doctor’s advice for treatment.
  7. Social media posts or surveillance evidence that contradicts your claim of disability, by depicting you in activities in which you are having a good time and/or actively involved in physical activities.

Having an application for long-term disability benefits denied is a frustrating and stressful experience, and for most applicants, it also creates a significant financial burden as they are deprived of an income.  Be aware that LTD benefits are often denied to people who genuinely qualify for disability benefits. In such cases, the insurance company is essentially failing to honour a contractual obligation to the applicant and the disabled person has the legal right to sue for owed benefits.   

Call Stevenson Whelton MacDonald & Swan if you would like to find out more about your legal rights and options, and what steps can be taken to favourably resolve your LTD claim.

 
Disclaimer: Our blog is intended to inform our existing and prospective clients about topics pertinent to their lives. While our goal is to provide accurate and factual information, this in no way should be taken as legal advice or applied to specific cases. It is in your best interest to contact a licenced and practising lawyer for legal representation, as matters of the law are often complicated and cannot be fully assessed without knowing all of the details of a case.