If you are insured under a policy that includes coverage for long-term disabilities, you have a right to LTD benefits if a disabling condition genuinely prevents you from working.

There are several reasons insurance companies use to deny claims, and they are often designed to discourage you from pursuing it any further. If your LTD claim was denied, it’s crucial that you don’t just take their word for it. Speak with a long-term disability lawyer in Toronto right away. 

LTD lawyers routinely see the reasons listed below on denial letters and know how to respond to the insurance company to get you the benefits you deserve.

The Claim Was Filed After the Deadline

Long-term disability policies usually have a time limit for how long you have to file a claim for LTD benefits after becoming disabled. Once the deadline passes, you are no longer able to qualify for benefits, according to the insurer. Insurance companies set these limits because they claim that without them, it makes it harder for them to properly manage their claims. The clock starts ticking as soon as the insured is injured or becomes ill. 

The issue is that insurance companies often argue that the date an insured was injured or became ill was actually earlier than the insured claims. For example, they will point to an appointment the insured had before the one in which the doctor diagnosed them with their current condition and say that the earlier appointment was when the insured knew or ought to have known about the condition that now disables them. This means that by the time the insured filed the claim, the time limit had already expired. 

The Insured is Not Totally Disabled

“Total disability” is a standard used in LTD policies to describe the criteria an insured must meet to qualify for LTD benefits. The term makes it sound like if you’re injured or ill; you won’t qualify unless you’re completely bedridden or in a wheelchair. 

The actual test to be classified as “totally disabled” is that you can no longer perform the essential elements of your work – that’s it. But when an insurance company denies an insured’s claim by saying that they are not “totally disabled,” they are basically saying that the illness or injury described by the insured shouldn’t prevent them from completing their tasks, or they should be able to if they’re given accommodations.

There is 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 are Your Options if Your LTD Claim is Denied

Most insurance companies provide insured persons with the ability to appeal a short-term or long-term disability benefits denial through an internal appeals process. Only under very specific circumstances, however, are these appeals ever successful. An example is if your claim is essentially guaranteed, but for missing or new information you can provide the insurance company. This is rarely the case.

The safest alternative is to consult a long-term disability lawyer who will sue the insurance company if they feel you have a case. Many LTD lawyers offer free consultations and contingency fees which means you don’t pay for their services unless they get you compensation from the insurance company. 

Lawsuits against the insurance company are typically settled fairly early on, but they must be filed within two years of the denial. This may seem like a lot of time; however, to get you the best settlement possible, your lawyer needs time to send you to medical appointments and order tests and records to build a solid case.