Long-Term Disability Denied? Here Are Your Options

Know Where to Begin in Ontario

Every year, many Ontarians apply for long-term disability for several reasons. But the unfortunate reality is, that many of these requests are denied, leaving hard-working individuals feeling hopeless, without knowing what their next steps are. If you’ve suffered from a serious personal injury, you may have life-long injuries that prevent you from returning to work. Having long-term disability denied can be an extremely stressful situation, but it’s not hopeless. There are many options out there for people who have been denied long-term disability.

If you are unsure about what your long-term disability policy covers, or your initial claim is denied, proper legal counsel can help guide you on the appropriate next steps to get the coverage that you need. Additionally, they can help you navigate the complicated appeals process and claim benefits that will improve you and your family’s lives for the foreseeable future. Serious disabilities will not only harm your quality of life, but they could result in an unnecessarily complicated burden for your children or partner. You all deserved to be secure financially in these scenarios, and that’s where legal counsel can help ensure you are.

Not to mention, long-term disability decisions can be highly subjective, and with the right legal counsel, you can fight for what is rightfully yours.

Long-Term Disability Denied: Common Reasons Everyone Should Know

As stated above, there are many reasons why your long-term disability claim was denied, but here are some of the most common reasons:

  • Complicated wording of insurance policies detailed in the fine print of your coverage. Oftentimes, important clauses and exemptions are listed in the fine print of insurance policies that could be overlooked. Providers might point to these exemptions as a reason for denying a claim.
  • Insufficient medical documentation could result in the denial of a claim as well. Should you be unable to produce requested medical documentation to your insurance provider it could result in your claim being denied.
  • In certain cases, there might only be a short window to file a claim for long-term disability. Should you choose to make a claim several days or weeks after the disability began, that could result in a denial.
  • Your insurance provider doesn’t consider you to be experiencing “total disability.” 
  • There are alternative occupations you can pursue while experiencing a disability.
  • The insurance provider is running surveillance on you as they suspect you are partaking in insurance fraud.
  • When filing a claim, you provided incorrect or incomplete information in your application resulting in a denied claim.
  • Conflicting information between your doctor’s medical reports and the insurance provider’s medical team reports.

Long-Term Disability Denied: What is Total Disability in Ontario?

Total or permanent disability refers to when an individual is unable to work in the occupation they were trained or suited for due to either sickness or injury. Sometimes total disability is referred to as Total Permanent Disability (TPD).

What Personal Injuries Cause Total Disability?

Typically, catastrophic injuries are described as causing total disability and can include:

  • Traumatic spin cord injuries resulting in paraplegia or quadriplegia.
  • Complete amputation that results in the loss of use of an arm or leg.
  • Traumatic injuries that result in permanent and severe brain injury.
  • Injuries that result in total loss of vision in both eyes.
  • Severe mental or behavioral impairment.

Learn About The Appeal Process

There are ways to appeal a long-term disability denial and receive benefits that are outlined in your insurance policy. Additionally, the process can be complicated and is best addressed with proper legal counsel.

Here are six steps you should take in the event you are denied long-term disability insurance:

  1. Take note of the deadline for appeal and reach out to legal counsel.
  2. Inform your employer that you are preparing to appeal the insurance decision.
  3. Prepare all necessary documents needed for the appeal process including detailed notes on doctor’s visits.
  4. Carefully read the fine print of your insurance policy including any exemptions that may impact your policy.
  5. Study your denial letter and begin drafting your appeal letter.
  6. Carefully review your appeal letter with your qualified legal counsel and send it to your insurance provider.

Long-Term Disability Denied: Appealing By Lawsuit

In instances when an appeal letter has failed, and long-term disability benefits are withheld by your insurance provider, Ontarians can push their claim with a lawsuit. In fact, most lawsuits are more successful with these kinds of cases as the original denial letter shows that your insurance provider has already made their decision in regard to your claim. Insurance providers control their appeal process and do not hire a third party to make a fair decision.

While the process of taking legal action against your insurance provider might seem intimidating, long-term disability lawyers can fight for what you are entitled to. Lawyers can seek out additional information, issue an official statement of claim, and can collect compensation should you experience damages from your insurance provider denying benefits in the first place.

There are many complicated legal steps for a successful lawsuit against an insurance provider, and Ontarians are encouraged to reach out to specialized legal counsel to ensure they receive the benefits that they are entitled to. 

Lean On The Experience of De Rose Lawyers

Consulting directly with a lawyer at any step of a long-term disability denial can be very helpful. Legal jargon along with the fine print hidden in many insurance policies can be difficult to understand. It is written in a way to be intentionally complicated. During these complicated times, having legal counsel on your side can make a major difference. It helps ensure that you and your family receive the compensation that is rightfully yours.

De Rose Lawyers specializes in long-term disability claims and can help guide people who have had their claims denied. Our legal team can advise on the best course of action that suits your needs. Whether it’s helping submit an initial claim or contesting a long-term disability denial, De Rose Lawyers offers experienced legal counsel. We specialize in handling issues related to long-term disability.

Contact us directly to learn more about legal services for Ontarians facing complications regarding long-term disability.