Denied Disability Benefits: What to Do When Your Claim Is Rejected Due to Insufficient Medical Evidence

If you're making a claim for short-term disability in Ontario, a strong medical record is essential. However, many claims are denied due to insufficient medical evidence, leaving applicants frustrated and financially strained. Insurance companies require detailed documentation proving the severity of your condition and its impact on your ability to work.

This blog explores why insurers deny claims due to inadequate medical evidence, how to strengthen your claim with proper medical documentation, the steps to take after a denial, and how a long-term disability lawyer can help you fight back.

Insurance companies require clear and objective medical proof that a condition prevents you from working. Common reasons for denial include:

• Lack of detailed medical reports — Brief doctor’s notes may not be enough to demonstrate your condition's severity.
• Inconsistent treatment history — Gaps in medical care or failure to follow recommended treatments can weaken your case.
• No specialist support — Reports from family doctors carry less weight than those from specialists.
• Failure to link the condition to work limitations — The insurer must see a direct connection between your illness/injury and your inability to work.
  

A long-term disability lawyer at Aaron Waxman and Associates can review your claim, gather missing evidence, and challenge an unfair denial. We understand how to present medical evidence in a way that meets the insurer’s strict criteria.

The lawyers at Aaron Waxman and Associates can order your medical records in support of your disability claim.

Tip: Ask your doctor to be as specific as possible about work restrictions caused by your condition.

Failing to follow prescribed treatments (e.g., physiotherapy, medication, counseling) can give insurers a reason to deny your claim. If you cannot follow a treatment recommendation due to side effects or financial reasons, ask your doctor to document this in your medical file. Additionally, if you and your doctor are of the view that a specific treatment will not be of benefit, then your medical records should indicate this.

Reports from specialists (e.g., neurologists, psychiatrists, orthopedic surgeons) carry more weight than those from family doctors. If you haven’t seen a specialist, and your doctor is of the view that your condition may be improved by referral to a specialist, then your doctor ought to make the appropriate referral.

1. Request the denial letter — Review the reasons for rejection.
2. Consult a disability lawyer — Contact Aaron Waxman and Associates for a free consultation.
   

If your disability claim was denied due to insufficient medical evidence, the lawyers at Aaron Waxman and Associates P.C. can assist in gathering the necessary medical documentation, communicating with doctors and specialists to strengthen your claim, and challenging the insurance company’s decision to secure the benefits you deserve.