Top 5 Reasons Why Your Long-Term Disability Claim Might Be Denied
Long-term disability (LTD) benefits are a type of insurance policy that provides financial support for individuals who are unable to work for an extended period of time due to serious illness, disability, or injury. This insurance policy provides you with benefits that can last for several years, and in some cases, to retirement age.
However, most insurance firms find a way to deny or terminate these benefits at critical periods, leaving you with little or no income, which leads you to contact a long-term disability lawyer about the situation.
In our experience, the reasons cited for denials are usually not supported by the facts, while some hold strong criteria.
In this blog, we will highlight medical conditions that qualify for LTD and discuss the top five reasons why LTD claims might be denied, offering guidance on how to avoid these pitfalls.
Medical Conditions That Qualify for LTD
When applying for LTD claims, certain medical conditions are commonly recognized by insurance companies, including the following:
- Chronic Pain Syndrome
- Cancer
- Multiple Sclerosis (MS)
- Severe Depression
- Rheumatoid Arthritis
- Heart Disease
- Traumatic Brain Injury (TBI)
- Parkinson’s Disease
- Fibromyalgia
- Severe Anxiety Disorders
- Lupus
- Chronic Fatigue Syndrome (CFS)
- Stroke
- Spinal Disorders
- Bipolar Disorder
- Chronic Obstructive Pulmonary Disease (COPD)
- Epilepsy
- Diabetes with Complications
- Lyme Disease
- Post-Traumatic Stress Disorder (PTSD)
Below, we discuss some reasons why LTD claims are denied or terminated.
1. Incomplete or inaccurate information
One of the most common reasons for LTD claim denials or terminations is missing or incomplete information, which entails failing to provide detailed medical records, omitting relevant employment history, or incorrectly filling out forms.
For instance, if you fail to include a recent surgery in your medical history, the insurance company may question the severity of the disability and deny the claim. Similarly, inaccurate or missing information can make it challenging to prove lost wages, which further complicates the process of a successful LTD claim.
To avoid making these mistakes, it is important to ensure that all necessary information is included and double-checked for accuracy.
2. Lack of medical evidence
Without strong medical evidence, insurance companies are likely to deny your claim based on the argument that disability is not well-detailed, documented, or severe enough to warrant benefits.
Some common types of medical evidence required includes:
- History of medical records
- Records of past hospitalization and surgeries
- Diagnosis test results (such as blood tests, X-rays, and MRIs)
- Treatment procedures
- Progress notes
- Letters from physicians and specialists
These documents can be easily obtained from your healthcare providers. Make sure to also consistently update records and submit the most current and relevant information to support your claim.
3. Missed deadlines
Usually, the LTD claims process entails many deadlines, which include set dates for the initial submission of claims, providing additional information or documents, and appealing denials. Missing these set deadlines can result in the denial or termination of LTD benefits.
To avoid being a victim of this mistake, create strategies such as a timeline of important dates, setting reminders on calendars, and maintaining organized records of all correspondence.
It is important to note that a long-term disability lawyer can help manage these deadlines, submit important documents, and provide guidance during a potential appeal process, which alleviates stress and increases the chances of a favourable outcome.
4. Not meeting the definition of a disability
In Canada, insurance firms view disability as the inability to perform the duties of one’s own occupation due to a medical condition. This definition can vary between insurance policies, with some considering disability as the inability to work in any capacity, while others may require an inability to perform specific tasks related to one’s job.
Common reasons for failing to meet these definitions include insufficient medical evidence, lack of ongoing treatment, or failure to prove how the disability has impacted the “ability to work in any capacity.”
We recommend carefully reviewing the definition of disability included in your policy, proper records of medical documents, and continuous communication with healthcare providers. Additionally, it is best to seek clarification with your insurer regarding unclear terms to avoid misinterpretation.
5. Surveillance and social media
Insurance firms always use surveillance and social media channels to investigate disability claims, seeking to clarify the legitimacy of your condition and activities.
Surveillance can include video footage, photographs, and tracking of daily activities. Social media monitoring entails scrutiny of pictures, posts, and interactions on platforms like Twitter, Instagram, and Facebook.
Examples of surveillance and social media leading to a claim denial or termination include instances where a claimant was observed to engage in activities that contradict their reported limitations, such as physical exercises, travel, hiking, and much more.
To avoid complications, you should always be cautious about your public and online presence. Do not share pictures, videos, posts, or other information that could be misinterpreted.
It is important to note that while surveillance is not illegal in Canada, it must be conducted ethically and without violating your privacy rights. You should be aware of your rights and contact legal representatives if you believe your privacy has been unlawfully invaded.
Why You Need a Long-Term Disability Lawyer
A long-term disability lawyer offers deep case evaluations to identify the strengths and weaknesses of your LTD claim. These legal representatives gather and organize detailed medical services, communicate with healthcare providers, and clarify that all submitted information and documents meet the requirements of the insurer.
At Affinity Law, we have a team of seasoned long-term disability lawyers that will pursue an LTD claim on your behalf. As one of the best law firms in Brampton, London, Markham, Mississauga, Scarborough, and Alberta, we will not rest or back down until you get the benefits you deserve!
We always go the extra mile through direct negotiations with insurance companies in a bid to settle disputes without the need for litigation. If necessary, our long-term disability lawyers are ready to represent you in court and advocate for your rights.
We Can Help With a Denied or Terminated LTD Benefit
Handling an LTD claim can be daunting, especially when facing a denial. We’ve discussed the importance of understanding policy definitions, meeting deadlines, and being cautious with surveillance and social media.
If your claim has been denied, remember that you’re not alone. Our professional long-term disability lawyers can greatly improve your chances of success through expert guidance and dedicated support throughout the process. Don’t let a denial deter you!
For more information, call Affinity Law at 1-844-786-8766 or contact us online for a consultation and take the first step toward securing the benefits you deserve.