Long-Term Disability Denials

Many Canadians are covered under a long-term disability plan.  Some of these plans are group plans that are provided through employment, others are private plans that require underwriting and approval from the insurance company before coverage begins.  Regardless of the long-term disability plan you are covered under, no one wants to have to access those benefits if they don't have to.  Unfortunately, whether due to illness or injury, there are numerous causes that can lead to a long-term disability which render individuals unable to work and force them to access their long-term disability benefits.  Sadly, even when your doctor(s) and employer is on your side a large amount of Canadian long-term disability claims are denied.  When that happens, you'll need to find an experienced insurance denial lawyer to help you enforce your rights to long-term disability benefits.

Types Of Disabilities

There are numerous types of illnesses and injuries that can result in a long-term disability; however they can often be separated into three general categories: objective injuries or illness, subjective injuries or illness and emotional injuries or illness.

Objective injuries or illnesses that lead to long-term disabilities are ones where there is objective evidence of the disability that is observable and measurable.  These are the most difficult causes of disability for insurance companies to deny and examples include:

• Multiple Sclerosis
• Arthritis
• Cancer and Related Treatments
• Benign Brain Tumour
• Epilepsy
• Lung / Respiratory Issues
• Diabetes
• Stroke
• Loss of Hearing
• Loss of Vision
• Vestibular Disorders
• Brain Injury
• Spinal Cord Injuries
• Fractures

Subjective injuries or illnesses are ones based primarily on self-reporting and are not easily observed or measured.  Due to their very nature these types of disability are far more often denied coverage in long-term disability claims.  Examples of subjective injuries or illnesses include:

• Long COVID
• Multiple Chemical Sensitivity Syndrome
• Chronic Complex Pain Syndrome
• Chronic Fatigue Syndrome
• Fibromyalgia
• Whiplash and Other Soft Tissue Injuries
• Concussions / Head Injury

Lastly there are the emotional or psychological injuries or illness which lead to disability.  These are also commonly denied in long-term disability claims as they are difficult to quantify in a measurable way, despite being well recognized in medical science.  Examples of such disabilities include:

• Conversion Disorder
• Psychological Disability
• Post-Traumatic Stress Disorder (PTSD)
• Depression
• Anxiety Disorder
• Mood Disorder
• Agoraphobia
• Situational Phobias
• Panic Disorder
• Bi-Polar Disorder
• Obsessive-Compulsive Disorder (OCD)
• Schizophrenia
• Personality Disorder

Subjective and emotional disabilities are often referred to as “invisible disabilities” and these are frequently denied by insurance companies as they lack objective evidence to support the ongoing disability.

Reasons Your Long-Term Disability May Be Denied

There are many reasons your long-term disability claim could be denied.  Some of the most common are pre-existing issues, failure to meet the definition of disabled under the policy or just that the insurance company feels you are no longer disabled.   

Pre-existing issues are one of the most common reasons long-term disability claims are denied.  Most policies will not cover injuries or illnesses that pre-date the effective date of your long-term disability coverage.  It does not matter if you were aware of the existence of the pre-existing illness or injury, so long as it was in existence prior to your insurance coverage taking effect and insurance company can deny you long-term disability benefits.

Another common reason to deny long-term disability coverage is that you fail to meet the definition of disabled under your policy of insurance.  At the end of the day, the language of your specific policy is what matters when considering if there is coverage, not whether you or your doctor believe that you are disabled from work.  Even if you initially meet the definition of disabled under your policy, the definition can change, with the first two years of disability often only requiring you from being disabled from your specific job.  After the first two years the definition of disability frequently changes to you being disabled from any job you are suited for, a much higher bar to meet and often the time when insurance companies deny ongoing long-term disability benefits.

Lastly, if there is no other good reason to deny your claim, insurance companies can just say that they believe you can return to work, so they’re cutting off your long-term disability benefits.  This is often done in the face of medical evidence to the contrary and against the opinion of treating medical practitioners. 

What To Do When Your Long-Term Disability Has Been Denied?

Regardless as to whether or not the insurance company’s reason has any validity, what do you do when your long-term disability has been denied?

There is often the option of an internal appeal of the decision to deny your long-term disability benefits.  This is often a waste of time as you are appealing to the same insurer who has already decided to deny you disability benefits and likely already has access to all your medical documentation that supports your ongoing disability.

The other option is to bring a lawsuit to enforce your rights under your insurance policy.  Most insurance companies deny long-term disability benefits hoping that their insureds will simply accept the decision and walk away from their claim.  However, with the help of an insurance denial lawyer you can force the insurance company to pay you the benefits you are entitled to.

If your long-term disability claim has been wrongly denied you should contact an experienced insurance denial lawyer as soon as possible.  There are strict timelines for when you need to bring your claim that can be dependent on the language of your policy.