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Published October 14, 2020

Long-term disability denied? MG Law understands that this is one of the most stressful times in your life. That’s why our team, with over 10 years of experience, is here to help and guide you through the legal process when you’re denied long-term disability insurance.

This blog will explain how you can pursue the coverage you’re entitled to when a serious medical condition, illness or injury stops you from returning to work. We know it’s your priority is to get better while continuing to pay bills and support your family. With MG Law in your corner, you can concentrate on what’s really important – making a full recovery.

Can you be denied long-term disability?

In short, yes. Long-term disability applications are denied for multiple reasons listed later in this blog. But ultimately, insurance companies’ goal is to make money. These companies sell insurance to individuals to provide them the peace of mind they need. However, they make a profit when not paying for claims. Insurance companies receive hundreds of claims a day. For every valid claim, there are many more false claims that raise suspicion and doubt.

As such, to protect their own interests, insurance companies often need any morsel of evidence to deny a claim. While long-term disability insurance is designed to provide respite when you’re injured or ill and unable to work, the reality is that many Ontarians face claim denials, terminations and delays.

Reasons given for denied long-term disability insurance

Firstly, when individuals are denied long-term disability insurance, it is highly subjective. Decisions will be based on the intricate wording of insurance policies and the interpretation of key terms. Long-term disability policies are purposefully written with highly complex legal language and provisions that are unclear to everyday individuals. This is intentional, so you are put off from making a claim.

These are some of the most common things individuals hear when long-term disability applications are denied.

  • “There is insufficient medical documentation”
  • “Unfortunately, you failed to submit your application on time”
  • “You aren’t experiencing ‘total disability’”
  • “There are alternative occupations you can pursue right now”
  • “We have been running surveillance on you”
  • “There is incorrect or missing information in your application”
  • “Our medical team doesn’t think you’re disabled”
  • “There is conflicting information between your doctor’s medical reports and our medical team’s reports”

Can I appeal long-term disability denial?

The process for completing a long-term disability denial appeal is as follows:

1. Take note of the deadline for appeal

When individuals experience long-term disability claim denials, they often receive a letter stating that they can appeal the decision. Remember, you simply cannot miss the deadline to appeal. Typically, the deadline for appeal will be included in the final few paragraphs of the letter.

2. Remember you have employment rights

After your claim is denied, insurance companies also send a letter to your employer. This letter will state that you’re unable to work and don’t qualify for long-term disability. Your employer will be suspicious but you simply need to inform them that you disagree and are appealing their decision. Circumstances vary but reasonable employers will still grant you unpaid sick leave during the appeals process. Others may demand you return.

3. Prepare all necessary documents for your appeal

A successful long-term disability appeal requires many documents. These include a denial letter from your claim representative, the manual that describes your long-term disability benefits, and a copy of your doctor’s medical file. The latter document provides explicit proof of your claim. Other important documents include the insurance company’s claim file, if your claim was over six months ago, and a copy of your union’s collective agreement if applicable.

4. Research other benefits you could be entitled to

Unfortunately, long-term disability appeals take time. In that time, you’ll need alternative sources of income and support. Take time to research whether you qualify for employment insurance (EI) or other forms of disability benefit.

5. Study your denial letter and finalize documents for your appeal

Insurance companies must give a reason to deny long-term disability. The best-case scenario is when your denial letter lists specific documents that are necessary for your appeal. Often, missing medical information creates the biggest problems. Missing medical information will be written technically to put you off but remember, you can still consult with your family doctor to clarify your diagnosis, prognosis, treatment plan, and so on. In instances where the insurance company’s reasons aren’t so clear, consulting with an Ottawa long-term disability lawyer like MG Law can help.

6. Finalize and send your appeal letter

This is the stressful part, as clients want to ensure they’ve prepared the strongest appeal possible. While your letter is important, it’s actually your medical records that hold the weight in reversing the insurance company’s denial of your claim. In basic terms, your appeal letter must simply state that you are requesting an appeal; you’re attaching documents in support of your appeal, and you’re taking action before the insurance company’s stated deadline. After submitting your appeal letter, you’ll typically get a response within 30 to 60 days.

What happens if my long-term disability appeal fails?

If you’ve exhausted long-term disability appeals, the next step is an appeal by lawsuit. Firstly, it’s important to be aware of timeframes. For lawsuits against insurance companies, there is a strict 2-year limitation period that begins from the moment your claim is denied.

Ultimately, insurers don’t have to pay your claim or worry about being sued in court when you miss this strict time limit. In short, the clock starts ticking as soon as your claim is denied. All in all, you have to make the decision whether to spend time with the appeals process or alternatively, hiring a long-term disability denial lawyer to start an effective defence of your claim.

Denied long-term disability insurance? Contact MG Law

When an insurance company wrongfully denies your claim, you need to seek competent legal advice as soon as possible. To move forward, your best bet is to hire experienced long-term disability denial lawyers like MG Law. Not only will we review your rights and remedies, we’ll work with you every step of the way to ensure your benefits are reinstated.

Since 2009, we’ve proudly served clients based in Ottawa and beyond. Long-term disability insurance is our passion and we care about getting the best outcomes for our clients. We believe everybody wants to work. That’s why our team will work tirelessly to help you make sense of complicated legal language while adhering to all

deadlines and processes required to get you the maximum benefits owed to you and your family.

Our team is ready to help you move forward. Call (613) 730-8460 today for your free consultation.

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