You have submitted your initial claim to your insurance company for long-term disability benefits after a serious accident, and your claim has been denied. Alternatively, you have successfully been receiving long-term disability benefits from your insurance company which have suddenly been terminated. What rights do you have, if any, to challenge the insurer’s decision to deny or terminate?
If you or a loved one has been wrongfully denied benefits or had your benefits terminated, it’s important to speak with a disability lawyer as soon as possible to help you with your claim.
The most common reason for a denial of benefits is that the insurance company no longer finds that you are disabled enough to require benefits. Particularly, the insurer might believe that you are able to work in any type of occupation despite some limitations or restrictions. This might be the case even though your doctor maintains that you are still disabled, and in many instances, the insurance company has wrongfully denied the benefits.
If you have been wrongfully denied disability benefits you might be able to sue the insurance company for breach of contract for wrongful denial of benefits you are entitled to. A disability lawyer can determine whether your insurance company acted unfairly when they denied your claim and you may also sue for ‘bad faith’.
During the litigation you will likely have to undergo medical assessments both with your own doctor or a specialist and a doctor chosen by the insurance company. You will have to take part in settlement negotiations, and potentially mediation will occur. Going to trial will be the final step, which is usually unnecessary as the majority of all lawsuits settle beforehand. In the process of suing for disability benefits, the majority of lawsuits reach a successful settlement during the process of negotiations and mediation. Many cases settle on the basis that the insurance company and claimant agree on an amount of money that represents a full and final payment to you for past and future long-term disability insurance benefits.
Steps to take to ensure that your claim is not denied, or that it is re-instated, include maintaining regular care and treatment for your disability. This means visiting your doctor on a regular basis, being examined and treated by specialists when necessary, and ensuring that you take medication as prescribed by your treating physicians. This is all evidence to demonstrate that you are suffering from a valid disability and thus are unable to work.
Many claims are denied on the basis that the insurance company finds a lack of objective evidence to substantiate your disability claim. After a serious motor vehicle accident, many victims suffer from “subjective” disabilities, such as fibromyalgia and anxiety disorders. From a legal perspective, courts across Canada have accepted that “subjective” disabilities can prevent an individual from being able to work, and renders them disabled – entitling the claimant to disability benefits. As the medical and legal community accepts the existence and validity of “subjective” disabilities and that such conditions can be disabling, it is unreasonable for an insurance company to deny a disability claim solely on the grounds of a lack of objective evidence.
It is important that you try to find out why your benefits have been denied or terminated. A disability lawyer can assist in making this determination and to assess whether your rights were wrongfully denied. Due to deadlines for filing a claim against your disability insurance provider, it is important that you seek out a qualified lawyer as soon as your disability claim is denied.
