Having your long-term disability (LTD) claim denied can be frustrating and confusing, particularly when your medical condition is preventing you from working. A denial, however, does not necessarily mean that you are not entitled to benefits.
As an experienced long-term disability lawyer, I regularly see legitimate claims denied for a variety of reasons.
Insufficient “Objective” Medical Evidence
One common issue is the insurer’s position that there is insufficient “objective” medical evidence supporting the disability. This can be particularly problematic for conditions such as chronic pain, fibromyalgia, migraines, mental health conditions and other illnesses where symptoms may not always be fully demonstrated through imaging or laboratory testing. The proper question is not simply whether a particular test is abnormal, but whether your medical condition prevents you from performing the duties of your occupation or any occupation as required by the specific policy in question.
Other Common Reasons Insurers Deny LTD Claims
Claims may also be denied because the insurer believes you have not received appropriate treatment, that you should be capable of modified work, or that the medical evidence does not support the restrictions identified by your treating doctors. In other cases, the insurer may rely on its own medical consultants or surveillance evidence to challenge the claim.
What to Do If Your LTD Benefits Are Denied or Terminated
If your LTD benefits have been denied or terminated, it is important to have a lawyer review the actual insurance policy, the insurer’s reasons for denial and the medical evidence supporting your disability. Internal appeals are not your only option – they are not always recommended – and there are limitation periods connected to a lawsuit that may affect your legal rights.
How Our Long-Term Disability Lawyers Can Help
At Howie, Sacks & Henry LLP, we can assess your denial, identify weaknesses in the insurer’s position and advise you on the appropriate next steps to pursue the benefits to which you may be entitled. Brad Moscato is recognized by the Lexpert Directory for both Long Term Disability and Personal Injury categories, the Best Lawyers in Canada directory, Post City’s Toronto’s Top Lawyers as well as being an LSO Certified Specialist in Civil Litigation.
