Denied Long-Term Disability Claims: What Steps Should You Take?

Dealing with a denied long-term disability (LTD) claim can be incredibly stressful, especially when you’re already struggling with a health condition. If your LTD claim has been denied, it’s important to know your rights and understand the steps you can take to address the denied benefits. This guide will cover why claims are often denied, common mistakes made by claimants, and the legal actions that can help you.

Why Are Long-Term Disability Claims Denied?

Insurance companies deny long-term disability claims for various reasons. Understanding these reasons can help you avoid pitfalls and build a stronger case. Here are some common grounds for denial:

1. Insufficient Medical Evidence
   One of the most frequent reasons for denial is a lack of comprehensive medical documentation supporting your disability. The insurance company may claim that the medical evidence does not adequately demonstrate how your condition prevents you from working.
2. Policy Limitations or Exclusions
   Your LTD policy may have specific exclusions or limitations that disqualify certain medical conditions. It is essential to read your policy carefully to understand what is covered and what is not.
3. Pre-existing Conditions Clause
   If your disability is related to a pre-existing condition, the insurer may argue that it is excluded from coverage. Many policies include clauses that exclude coverage for conditions that existed before the policy started.
4. Missed Deadlines and Incomplete Applications
   Filing your claim late or submitting incomplete forms can result in an automatic denial. It's crucial to follow all instructions carefully and meet all deadlines to avoid this.

Common Mistakes That Lead to LTD Claim Denials

To improve your chances of a successful claim, it's important to avoid common mistakes. Here are some errors to watch out for:

1. Not Following Medical Advice
   Failure to follow your doctor's recommendations, such as attending physical therapy or taking prescribed medications, can be used by the insurance company to argue that you are not truly disabled.
2. Gaps in Medical Treatment
   If there are significant gaps in your medical treatment, insurers may interpret this as a lack of seriousness about your condition. Maintaining consistent medical records is key.
3. Poor Communication with Your Doctor
   Your doctor needs to understand how your disability affects your ability to work. If this is not clearly documented, your insurer may argue that you are still capable of performing your job.
4. Inaccurate or Inconsistent Information
   Providing inconsistent information on your claim forms, medical records, or statements can damage your credibility. Always ensure that the details you provide are accurate and match across documents.

What Steps Should You Take After a Long-Term Disability Claim Denial?

If your LTD claim has been denied, don’t lose hope. There are steps you can take to address the denied claim.

1. Review the Denial Letter Carefully
   The first step is to thoroughly review the denial letter from the insurance company. It should detail the reasons for the denial and any supporting evidence. Understanding why your claim was denied will guide your next steps.
2. Consult a Long-Term Disability Lawyer
   If you are unsure how to proceed, consulting a lawyer who is well-versed in long-term disability claims in Ontario can significantly improve your chances of success. A lawyer can help you understand your rights, build a stronger case, and ensure that all paperwork is filed correctly.
   

How a Long-Term Disability Lawyer Can Help

When dealing with a denied LTD claim, having a lawyer on your side can make all the difference. An experienced disability lawyer can review your claim and identify weaknesses that need to be addressed, handle all communications with the insurer, represent you in legal proceedings, and negotiate for a fair settlement on your behalf.

How Can Aaron Waxman and Associates, P.C. Help?

At Aaron Waxman and Associates, P.C., we understand the challenges of dealing with a denied long-term disability claim. Our team is focused on supporting clients through every step of the process. We provide clear, practical advice on your rights and the legal steps you can take to challenge a denial. Our lawyers work closely with you to gather the necessary evidence and fight for your right to disability benefits, whether through negotiation or legal action. If your long-term disability claim has been denied, don’t hesitate to reach out. We offer a free consultation to review your case and discuss your options. Contact us at 416-661-4878 or awaxman@awaxmanlaw.ca for legal guidance.