Denied Long Term Disability Benefits?

As part of many employment contracts, employers may offer their employees medical benefits including long term disability coverage known as LTD coverage. In some cases, you may purchase your own LTD policy privately. For any policy, you expect that when you become disabled the insurance company will honour their agreement and pay disability benefits for the period you are disabled. In so many cases, this is simply not the reality. We regularly receive calls from persons who say they are ill or injured, have applied for disability benefits and supplied the requested medical records only to be given the run around by the insurance company and ultimately being denied coverage.

Where to turn to when your LTD insurer denies coverage?

Our lawyers handle hundreds of disability denial claims each year and have been very successful in obtaining benefits for our clients and overturning – reversing denials. In most cases, the insurer will deny coverage because they have insufficient or inadequate medical information to confirm the claimant is disabled as defined in the policy of insurance. Our disability lawyers follow a proven step by step process that is effective in obtaining the benefits to which our clients are entitled. Each file is unique and so our lawyers know that each client has particular and different needs to be addressed in the disability claim process.

Our lawyers have significant experience dealing with denials based on various grounds such as exclusions under the policy, lack of medical support, non-compliance with the policy and so on.

Initially, our lawyers will meet with you for free and assess your file. Our lawyers work on the basis of being paid from the settlement and only if settlement is reached. Our lawyers will then obtain a copy of the policy of insurance, review the terms of the policy and more specifically the test to meet to qualify as “disabled” under the policy. The entire file of the insurance company will also be requested and reviewed. Each policy is different and so careful review of the policy terms and conditions is extremely important. Once the terms of the policy and coverages are determined, a full review of the application filed by the claimant and all of the supporting medical records is completed. Where the medical evidence is lacking, our lawyers will arrange for needed medical assessments, often with medical experts, to support the medical finding of disability as it is defined in the policy of insurance. Our lawyers will solicit medical-legal reports from the various doctors.

Most policies of insurance will afford two types of coverages, usually for the first two years after the onset of disability, coverage is provided if the claimant is unable to do the essential tasks associated with their own job. In most cases, after two years, the definition and therefore the test changes to inability to work at any job for which the claimant is suited by education, experience, or training.

When we write to our clients’ medical practitioners, we specifically ask that the doctors provide an opinion that the person is disabled as defined specifically in the policy. In many cases, we support the claim with diagnostic test results (scans, x-rays, medical assessments etc…). Independent medical test results that support the disability is important.

Once the necessary medical information is obtained, they are submitted to the insurance company with a request that the denial decision be reversed and disability payments be paid retroactively, failing which legal action will be commenced. If the insurer maintains their denial in the face of clear medical evidence supporting the disability, we recommend commencing a court action claiming disability benefits and in many cases also claim punitive damages alleging the insurer acted in bad faith. Legal costs are always claimed as well as pre-judgment interest.

Claims for disability coverage are subject to limitation periods and it is important to consult a lawyer as soon as possible after a denial of coverage to ensure your court action is commenced before the limitation period expires.

For a free consultation, call us at 613-315-4878.

Ottawa Disability Lawyers
Marc Quinn