If you have had your long term disability denied, you should consider challenging that decision. Do not be afraid to challenge your disability insurance denial. Insurance companies can deny your disability insurance for a variety of reasons, and many are unfair. We will discuss common reasons why long term disability is denied and what you can do to fight it. Our long term disability lawyers at Monkhouse Law frequently assist employees who have had their disability insurance denied. If the employer has wrongfully denied insurance, the court can order the employer to pay.
Long Term Disability Denials are Common
While it may be shocking to have your disability insurance denied, it should not be surprising. Insurance companies deny most of the claims they receive. You should not simply assume the insurance company is correct. A denial does not necessarily mean your claim was weak, or that it will never be successful. It is quite possible that your claim would be successful if put before an impartial decision maker. You should therefore not be discouraged from continuing to seek your benefits. You should retain experienced long term disability lawyers to make sure you are not denied again. We encourage you to use our Disability Benefits Calculator to estimate the present value of your disability claim.
Common Reasons Why Disability Insurance is Denied
When your disability insurance is denied, you should closely review the denial letter to determine why the insurance company has chosen to deny your claim. While insurance companies use many reasons to justify denying a claim for long term disability benefits, a few are more common than others. These include:
- You are not “totally disabled”
The term “totally disabled” is rather deceptive. The term does not mean an employee must be completely incapacitated and unable to care for themselves. Instead, the term means an employee is unable to perform all their essential and material job duties substantially. An insurance company may make the argument that although you have a disability, it does not prevent you from performing your own occupation. As a result, you are not “totally disabled.”
This becomes even more challenging when an employee must prove they are unable to perform any occupation, not just their own occupation. An employee must typically demonstrate this to qualify for long term disability benefits. It is exceptionally difficult to meet this standard. It is essential to have an experienced long term disability lawyer supporting you.
- You provided insufficient medical documentation to prove you cannot work
The insurance company takes the position you failed to provide them with enough medical documentation to support your claim for disability insurance. This is particularly likely to arise where the disability is an invisible one such as depression, anxiety, or chronic pain.
- The insurance company disagrees with your doctor
The insurance company has their own medical professional, just as you do. It is common for the insurance company’s doctor to disagree with your doctor. The good news is that the insurance company’s doctor likely has less persuasive evidence than your personal doctor would. Your personal doctor will have had a significant amount of time to assess your condition, whereas the insurance company’s doctor’s time with you would be very limited. Their evidence may not be as holistic as your own doctor’s.
- Surveillance proves you are not disabled
An insurance company might hire a private investigator to surveil you to check if you truly are disabled. Although this sounds intimidating, an employee with a long-term disability should not worry too much. Often, the surveillance does not prove anything. The evidence will rarely be convincing enough in court. In addition, many disabilities are not visible disabilities.
Fighting your Denied Disability Insurance
Regardless of why the insurance company denied your claim, you should consider appealing. You should move quickly so there is no risk of missing any deadline. You can either appeal internally with the insurance company, or externally with the courts. There is a two-year deadline to appeal to the courts.
a) Appealing Internally
When you appeal internally, you ask the insurance company to reconsider their decision to deny your disability insurance. This is usually a waste of your time and not recommended. An insurance company is unlikely to reverse its earlier decision. It is not in their best financial interest to reverse the decision. The insurance company is not a neutral or impartial decision maker, as they have a financial stake in the result. In addition, the internal appeal process can be time consuming. You do not want to spend so much time appealing internally that you miss the deadline to appeal externally which, in any event, is a more efficient method of appealing your denied disability insurance. In summary, while the internal appeal process might seem like the most practical option, it will take up valuable time and will often be unsuccessful.
b) Appealing Externally
A better option for appealing your disability insurance denial is to appeal externally with the help of a disability lawyer. Here, you appeal not to the insurance company but rather to the courts and legal system. Put simply, appealing externally means suing the insurance company for wrongful denial of disability benefits. The decisionmaker in this context will be neutral and will have no financial interest in the decision. They will have no incentive to simply uphold the previous decision of the insurance company.
Furthermore, it is unlikely that your case will go all the way to trial. It is far more likely that a settlement will be reached ahead of trial. This is a faster result for you and guarantees money in your pocket.
The Deadline to Sue is Two Years
An employee who has had their disability insurance denied generally has two years from the initial denial to sue the insurance company. You should remember this when deciding which appeal option to pursue. Be wary of continuously appealing the decision internally. An insurance company will happily delay an internal appeal if it means you might miss the two-year limitation period. It is essential that you do not miss this deadline because if you do, there is no going back – you will no longer be able to claim your long term disability benefits.
Have the Support of a Disability Lawyer
This is a complicated area of the law. If you have your disability insurance denied, you should not fight the insurance company on your own. It would be a difficult and stressful endeavour, with little likelihood of success. Instead, you should strongly consider hiring a long-term disability lawyer to fight the insurance company in your place. You will not have to worry about the complicated legal rules and procedure, or about communicating with the insurance company. The disability lawyers at Monkhouse Law would be happy to assist you if you have had your long term disability denied.
This was written by Shane Burton-Stoner, an Employment Lawyer at Monkhouse Law. Monkhouse Law is an employment law firm located in Toronto with a focus on workers’ issues. Give us a call at 416-907-9249 or fill out this quick form. We offer a free 30-minute phone consultation.