Denied: Why Your LTD Claim Wasn’t Approved & What to Do About it
Nov 12, 2022
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If you have an insurance policy that includes coverage for long-term disabilities and have been paying into it (or your employer has on your behalf) for years, it can be frustrating if you need the support and the insurance company denies your legitimate claim for benefits.
There are several reasons insurance companies use to deny claims, and they are often designed to discourage you from pursuing your claim. If your LTD claim was denied, it’s crucial that you don’t just take their word for it. Speak with one of the leading long term disability lawyers in Toronto right away.
LTD lawyers see the reasons listed below on denial letters every day and know how to respond to get you the benefits you deserve.
Filing a Claim After the Deadline
Your insurance policy will provide a clear time limit between when your disability began and when you are no longer allowed to file a claim relating to that disability. This is one of many reasons to read your LTD policy carefully as soon as you are provided one.
The other crucial reason that’s related to the time limit is the scenario in which, as far as you are concerned, you submitted your claim on time, but your insurance company disagrees. They will reason that your disability actually began earlier than the date you entered on your application because of an incident in your medical history and use the date of that incident as the actual start of your disability.
A Pre-Existing Medical Condition
In a similar manner to the one above, insurance companies also deny claims for LTD benefits by referencing an incident in your medical history that predates the start of your policy and claiming it as proof that your current condition is actually a pre-existing condition that you didn’t disclose when you first joined the policy.
Your Condition is Not a Disability
Each policy has a specific term and definition for what classifies as a disability for which an insured is entitled to benefits. One of the most common terms is “total disability,” – which means that the person’s medical condition prevents them from being able to perform the main duties of their job.
If your LTD claim is denied for this reason, it is often the position of the insurance company that either your application failed to show a direct link between your symptoms and your inability to complete your work or that, despite your condition, you can still perform your work if your employer provides reasonable accommodations.
Not Enough Medical Evidence to Support Your Claim
If you and your doctor don’t provide enough evidence to back up the claims in your application for benefits, the insurance company will use this reason as grounds to deny your LTD claim. Insurance companies usually insist on “objective evidence,” like x-rays, blood tests, MRIs, etc., that clearly show the medical condition you claim.
This reason for denial is often used in applications for benefits based on what are known as “invisible injuries.” These mostly include mental illnesses but also apply to physical conditions like fibromyalgia, IBS, chronic pain and others for which there is no test or “objective evidence” to prove the condition.
What to do if Your LTD Claim is Denied
It’s crucial to know that the reason(s) cited in your denial letter, even a late application, can be contradicted – depending on the facts. Insurance companies routinely deny legitimate claims and hope the insured gives up. If, however, they receive a letter from a long-term disability lawyer, they are forced to take the claim seriously.
If your claim is denied, speak to a long-term disability lawyer right away. If they feel you have a legitimate claim, you can still get your benefits, but you only have a limited amount of time to respond.
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