By Nainesh Kotak
If you look below the surface of your long-term disability (LTD) denial, you may not find much substance.
Injured workers could be forgiven for thinking that every decision to deny much-needed benefits is the product of a thorough assessment of their situation. Sadly, after more than three decades in practice dedicated to advocating on behalf of injured clients, I know better than most that LTD insurers are more focused on their bottom lines than the interests of their insured workers.
As a result, their benefits denials are often far flimsier than the robust language of their rejection letters suggest. Look a little closer, however, and many claimants will notice some tell-tale indicators that the denial was made on the basis of a flawed or biased evaluation of your claim.
Whether your LTD denial has all or none of the following hallmarks, feel free to call a member of our team at 1-888-GOKOTAK or (416) 816-1500 so that we can assess your case and discuss your options. In the meantime, here are my top five LTD denial red flags.
Red Flag 1: Generic language
It doesn’t take much for an LTD insurer to deny a claim for benefits; sometimes, they don’t even bother offering much of an excuse.
Perfunctory denial letters that stick mainly to generic language or steer clear of analyzing the specifics of your claim should set alarm bells begin ringing that your claims may not have been looked at in a comprehensive way.
Red Flag 2: “Insufficient medical evidence”
In all my years of legal practice, there are few phrases I see more regularly in my daily practice than “insufficient medical evidence.”
This is the vague, catch-all term insurers use to cover any kind of doubt they have about a person’s loss of function as a result of their disability.
In the worst cases, the denial will not reference the insured person’s specific condition or the type of evidence they believe is lacking, as if those three words provide a full answer to their claim.
Red Flag 3: Ignoring the claimant’s medical professionals
As part of their application for LTD benefits, injured workers often submit reports from their family doctors and any other specialists they have been referred to for treatment.
Omitting any reference to these professionals or their evidence as part of a denial is a warning sign that the insurer may not have given your claim the treatment it deserved.
Red Flag 4: Reliance on the insurer’s medical experts
If there are any doctors whose evidence an insurer has given weight to in their denial letter, you can bet it was the insurance company who hired them.
Incredibly, these medical professionals could end up providing crucial evidence in an LTD case without ever meeting the claimant in person if the LTD insurer retained them to conduct a “paper review.” That’s the name for a process that sees an expert appointed by the insurer to read all the medical documents associated with a particular file to draw conclusions about the disabled person’s treatment options, rehabilitation progress and prognosis.
Red Flag 5: Reference to previous conditions
LTD denials based on previous or existing conditions – especially those unrelated to the person’s current disability — are among the ripest for a challenge.
Group LTD policies typically contain an exclusionary provision preventing claimants from obtaining coverage for an illness or injury related to a pre-existing condition, and we often see insurers attempt to inaccurately link older ailments to the newer problem, preventing the insured person from doing their job.
However, the insurer’s arguments will not always stand up to the scrutiny of a judge, and we will not hesitate to launch a claim on your behalf in court if one is required.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies, including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.
Call your trusted long-term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St. Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Fort Erie, Keswick, Kingston, Ottawa, Barrie, Timmins and other locations. We also serve clients throughout Alberta, including Calgary, Edmonton, Red Deer, Lethbridge, Medicine Hat, Fort McMurray, Grande Prairie, Airdrie, Spruce Grove, Lloydminster, St. Albert, Wetaskiwin, Camrose, Banff, Canmore, Jasper, Cochrane, Okotoks, High River, Sylvan Lake and others.