If you’ve suffered a long term disability in Etobicoke, you know that insurers are extremely motivated to avoid paying disability benefits. Disability sufferers often encounter countless questions about their injury, their treatment, and their ability to work.
That’s why you need a disability lawyer to force your insurance company to give you the benefits that you deserve. Call us today or fill out our free online assessment. You only stand to gain from taking charge of your disability claim.
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Etobicoke Disability Cases in the News
COMMON REASONS WHY LONG-TERM DISABILITY BENEFITS ARE DENIED
Many Etobicoke residents rely on long-term disability (LTD) coverage when an illness or injury prevents them from working for an extended period. In such circumstances, the income provided by LTD benefits allows individuals to continue to meet their financial obligations and participate in necessary medical treatments for their recovery.
Unfortunately, sometimes Etobicoke individuals who are disabled and deserve LTD benefits, are denied coverage by their insurer. Understanding why claims are denied can help claimants to avoid these pitfalls. Here are the most common reasons for denial of LTD coverage.
Evidence does not support the definition of ‘disabled’. A claimant must provide medical evidence that shows, for the first two years of becoming disabled, that they cannot perform the necessary duties of their current job; and after two years, medical evidence must support the fact that the claimant cannot perform the necessary duties of any occupation for which they are reasonably qualified by training, education or experience. A crucial aspect of a claimant’s evidence of disability, which includes medical opinions and reports provided by their physician, is that it demonstrates how a claimant’s condition or impairment limits their ability to perform their work.
Insufficient medical evidence. A claimant must provide objective and detailed medical evidence to support the disability that they are claiming, which includes medical reports provided by the claimant’s attending physicians, as well as any appropriate medical tests (such as X-rays, CT scans). Medical evidence should demonstrate that the individual was actively seeking the appropriate care for their illness or injury. For example, for a mental or psychological condition, this may require that the claimant has sought regular psychiatric/psychological counselling. It’s also important to ensure that no required medical reports were overlooked or not submitted to the insurer.
Too late in making an LTD claim. Your LTD insurance contract specifies dates by which you must notify the insurer that you are disabled and also, a deadline for providing medical evidence supporting a claim for LTD benefits. Insurers commonly deny claims for claimants who miss these contract dates or the limitation period, and claimants may lose their right to claim for disability benefits on this basis.
Failure to follow physician’s advice. If a claimant does not follow their physician’s recommended treatment, their LTD insurer can argue that the claimant is not contributing to their own recovery, and may deny their claim or terminate benefits.
The insurer’s ‘independent medical assessment’ provides an alternative opinion. Insurers may require a claimant to submit to an independent medical assessment by the insurer’s physicians, which often results in an ‘alternative’ medical opinion suggesting the claimant does not have a disability that prevents them from working. The insurer can use their ‘independent’ physician’s reports as grounds for denying or terminating LTD benefits.
Other reasons why LTD benefits are often denied in Etobicoke:
- Social media posts that suggest that a claimant is engaged in fun and active activities, which conflict with the claim that they are disabled by their injury or illness.
- Your insurer may hire an investigator to follow and record your activities, and if the investigator’s findings are inconsistent with your claims of impairment, an insurer can use this evidence to deny a claim. For example, a claimant whom is shovelling snow, carrying grocery bags, or performing heavy work, may be denied benefits if these activities are not consistent with their reported injuries or their physician’s recommendations.
- Pre-existing conditions may result in a denial of LTD benefits, but this is less common in group/employer plans. However, a group plan may require that a claimant not claim LTD benefits for any pre-existing condition that existed within a given period, such as one year prior to the claim for disability.
- A failure to be honest or misrepresenting your personal and/or medical information can result in a denial of LTD coverage.
If you intend to claim long-term disability benefits, ensure that your physician specifically identifies how your condition prevents you from doing your work – this is a vital element in your evidence of disability. However, if a disability prevents you from working and you were denied LTD benefits for any reason, call an experienced Etobicoke long term disability lawyer at Kotak Law to fight for your right to receive benefits you deserve.
Disclaimer: This article is intended to supply general information to the public. We make every effort to ensure the accuracy of this information. However, as laws change quickly, the reader should always ensure the accuracy and applicability of such information with respect to their particular case. The information contained in this article cannot replace a thorough and complete review of the reader’s situation by competent legal counsel who has had an opportunity to review all of the facts.
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