Common Reasons Long-Term Disability Claims Get Rejected in Ontario

Navigating a long-term disability (LTD) claim can be complex, especially when you’re already dealing with health issues, but you deserve financial peace of mind. Unfortunately, many LTD claims in Ontario are rejected by insurance companies. Understanding why these rejections happen is key to protecting your rights and ensuring you receive the benefits you’re entitled to.

At Fox Vanounou LLP, our Toronto long-term disability lawyers can help you if your LTD claim has been denied. We can advise you on reasons why your LTD claim may have been rejected, mistakes you should avoid, and steps you can take if your claim has been denied. To discuss your situation, schedule a consultation with our team today.

Common Reasons Long-Term Disability (LTD) Claims Are Denied

Even when you have a legitimate disability or illness that prevents you from working, insurers often deny LTD claims. This can be due to a variety of factors, such as:

• Insufficient Medical Evidence: Insurance companies expect thorough documentation that proves you genuinely have a disability that is preventing you from working. If your medical records or diagnosis appear insufficient, your insurer may question whether your condition has truly affected your job or employment.

• Lack of Consistent Treatment: If you fail to follow your doctor’s recommended treatments or miss appointments, your insurer might argue that you’re not doing everything necessary to improve your condition. This can lead them to assume your disability is not as severe as you say it is. As a result, your claim may be denied.

• Failure to Meet the Policy’s Definition of “Disability”: LTD policies typically contain strict definitions of what can be classified as a disability. Normally, this includes definitions for “total disability” or “inability to perform the essential duties” of your job. If you don’t meet this criteria, your insurer may decide to deny your claim.

• Pre-Existing Conditions: If an insurer believes that your disability stems from a condition that you had before the coverage period began–and your policy has a pre-existing condition clause–they might reject your claim.

• Missed Deadlines or Administrative Issues: Filing deadlines, application forms, and medical updates must be handled correctly. If you miss an important deadline or fail to update your paperwork when they request that you do, your claim can be denied, even if it is valid. 

In addition to these common reasons, we also sometimes see LTD claims denied because:

• There is surveillance that contradicts the claim that you are disabled
• An insurer assessor says that you are not disabled, usually during an Independent Medical Examination (IME)
• You have refused to go back to work or to participate in a gradual return to work program
• You have breached some provision of your LTD policy
• And more

Although this list is not exhaustive, it may help identify why your initial LTD claim has been denied. If you are facing a denial, you should contact our Toronto long-term disability lawyers. This way, you can identify the problems with your application and create strategies to challenge your insurer’s decision. Contact our legal team at Fox Vanounou LLP today.

What Can You Do if Your LTD Claim is Denied?

Having your long-term disability claim denied is not ideal. However, denial is not necessarily the end of the road. There are steps you can take to seek the benefits you need while you recover:

• Review Your Denial Letter Carefully: Insurance companies are required by law to explain exactly why they denied your claim. Read the notice you receive carefully to understand the specific reasons. Whether it’s insufficient medical proof, missed deadlines, or policy exclusions, knowing the reason why your claim was denied can help you and your legal team create a strategy to address the problem.

• Gather Detailed Evidence: You can strengthen your LTD claim by collecting all relevant medical records, test results, and other helpful evidence. With more detailed documentation to back you up, you can counter your insurer’s reasons for denial. 

• Request an Internal Appeal: Many LTD policies include the option to appeal directly to the insurance company when your claim is denied. This normally involves submitting new evidence or documentation. However, make sure you follow all timelines and procedures for appeal outlined in your policy to prevent another rejection. A dedicated LTD lawyer will know the best type of evidence to compile and the deadlines you must meet when you are considering an internal appeal. 

• Consult a Toronto Long-Term Disability Lawyer: Our Toronto long-term disability lawyers at Fox Vanounou LLP have extensive experience guiding clients through their insurance policy’s appeals process, or pursuing litigation when necessary. We can also negotiate with your insurance company on your behalf and help you avoid common pitfalls.

• Consider Legal Action or a Lawsuit: If internal appeals fail or your insurer refuses to reverse its decision, you may be entitled to file a lawsuit. With legal representation on your side, you can feel more confident pursuing the compensation you deserve throughout the legal process.

Has Your Ontario LTD Claim Been Denied? Our Toronto Long-Term Disability Lawyers Can Help

If your LTD claim has been denied, or you anticipate challenges during your application process, you don’t have to face your insurance company alone. At Fox Vanounou LLP, our Toronto long-term disability lawyers have extensive experience navigating the complexities of LTD insurance claims in Ontario. Call our Toronto office at (416) 222-8400, email our team at info@fvlaw.ca, or fill out our online contact form to get started with your case today.