Long-Term Disability Denied? Here Are Your Options

Long-term disability provides income relief for those who need it most. But what happens when long-term disability is denied? Learn what to do next from our personal injury lawyers.

What is long-term disability in Ontario?

There are few things more challenging than facing long-term disability after a severe accident, but receiving a denial letter from your LTD insurance pours salt in the wound. It’s a common misconception that a disability claim denial is a final, crushing blow. Still, you have a legal right to appeal the denial and fight to overturn the decision and access the benefits you rightfully deserve.

Our personal injury lawyers have seen it all and deeply understand Ontario disability laws. We’ve built this guide to help you through the following steps to help you fight and start the road to financial, legal, and physical recovery.

Understanding Long-Term Disability Ontario

What is totally disabled in long term disability?

In Ontario, long-term disability insurance helps replace the income for people who cannot work due to a physical or mental disability. If the disability keeps you from performing your essential work duties, benefits may replace part of your income. Most people typically receive 50% to 80% of their income, though not everyone has a smooth ride through the claim system.

Whether you have Canada Life long term disability, Sunlife disability insurance, or some other type of coverage, policies vary by provider.

Ontario long term disability payouts also vary based on your policy monthly benefit caps, additional income benefits you receive, and the duration of the benefits outlined in the insurance policies. Remember that depending on how the insurance premiums were paid, your benefits may be considered taxable income.

Why Was My LTD Claim Denied?

When a long-term disability claim is made, insurance companies review the case and decide whether to approve or deny it. Unfortunately, insurance companies are profit-driven businesses, so they’re often working to keep payouts to a minimum.

Insurance companies often use these strategies to deny or minimize claims:

• Lack of medical evidence. If the adjuster feels the medical records don’t adequately prove the disability to the severity of the claim, they may argue their validity.
• Insufficient documentation. If your claim lacks essential documents like medical records, test reports, and treatment plans, they may feel the evidence is insufficient.
• Policy exclusions. If your policy excludes specific illnesses or pre-existing conditions, it may not cover your disability needs.
• Disability definition issues. If the policyholder does not meet the definition of “disability” in the policy or that definition changes from limitations in your own occupation to those in any occupation. Your benefits may be denied or stopped if they feel you can work another job.
• Dangerous occupation exceptions. Your claim may be dismissed if you worked in certain hazardous occupations and your illness or injury was caused while working.
• Late claims and missed deadlines. There are limitations on how long you can take to make a long-term disability claim. If you miss those deadlines, your claim could be refused.

What’s Next: Steps to Take After a Disability Insurance Claim Denial

It can be devastating to get that rejection letter, but use it as the roadmap to your success.

#1: Review the Denial Letter

Review your denial letter to understand the detailed reasons for denial, relevant policy clauses, and deadlines for filing the appeal or taking legal action.

#2: Strengthen Your Medical Evidence

Your medical evidence is often the critical factor in your LTD approval or denial. If you need more sufficient documentation, call your treating physicians and schedule appointments, discuss the letter, and explain which details you need to appeal the denial. Ensure you have written proof and documentation, get a functional capacity evaluation, and secure an independent medical examination so you have multiple trusted experts backing up your claims.

#3: Call a Disability Lawyer

The road ahead to fight for long term disability benefits is complex and full of legal technicalities and difficult communications. A lawyer proves a valuable ally, assessing the merits of your case, building a legal strategy, gathering evidence, and advocating for your rights with challenging insurance companies. If negotiations fail, they can initiate legal proceedings, organize the case, and represent you in court.

The Appeals Process: Internal and External

Internal appeals start within the insurance company. When you appeal the adjuster’s decision, you submit additional medical evidence and counter-argue their claims.

After you’ve exhausted internal options, you can escalate the case to court and start external appeals. The insurance company isn’t all-powerful, and they must abide by any legal rulings if a court feels the case was mishandled or unjustly denied.

Don’t let denial be the end of the road.

If you’re denied LTD benefits in your disability coverage, your fight doesn’t have to be over. With the right disability lawyers and medication documentation, you can appeal the company’s decision and fight for the financial security you deserve.

The Morris Law Group—Personal Injury Lawyer Near Me

At the Morris Law Group, our personal injury lawyer attorney team is ready to help you through your long-term disability insurance claim to fight for your livelihood. Our health and legal advocates can help you navigate complex insurance and legal systems for the best outcomes possible. Request a free consultation with our personal injury attorneys, or call us at 905-526-8080 to learn more.