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How Unclear Medical Records Can Lead To Denied Disability in Ontario

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How Unclear Medical Records Can Lead To Denied Disability in Ontario

Don’t delay discussing your matter with us to find out how to build a winning case.

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You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.
denied disability in ontario

Accurate Medical Records Help With Claim Success

If you keep accurate, detailed medical records, you’ll have a much easier time if you ever need to file a disability claim. That’s because both government and private insurance programs mandate that all medical conditions be meticulously documented before any disability claims get paid and can be the major contributor to denied disability claims in Ontario.

This guideline applies not just to Canada Pension Plan (CPP) claims but to employer-funded and private insurance plans as well. In the insurance industry, particularly the medical/disability sector, documentation is of paramount importance.

When you don’t have sufficiently detailed records, or when you have no records at all, insurers have no way of knowing whether your claim is legitimate. What’s the definition of “good medical records,” and why are claims sometimes denied by private and government insurers, like the CPP?

Additionally, how can a lawyer help you if you need clarification on these questions or wish to get help if you were previously denied disability in Ontario?

Why Good Medical Records are a Must

Good medical records consist of timely, accurate, complete documents that honestly and clearly state when and what you were treated for, by whom you were treated, why you were treated, and what the outcome was.

These seven components of “accurate medical records” are the minimum criteria to meet the definition, namely:

  • Timeliness: the records should be created at the time the treatment is given, not later
  • Accuracy: documentation should contain only those medical services that were performed
  • Completeness: records should be detailed enough so as to offer a full, understandable picture of what was done
  • Date of service: the actual dates that medical services were provided to you.
  • Reason for treatment: within the medical record, there should be a statement by the professional care provider explaining why you sought treatment
  • Provider: the name, address, credentials, and contact information of the medical provider
  • Outcome: what happened as a result of the treatment you sought and received

Why Claims are Denied

If you have been denied disability in Ontario for a private or CPP claim, the insurer will inform you of the reason for the denial. In many cases, denials are a direct result of inadequate medical records. In addition to private disability insurance coverage, Canada has had an official government program, called the Canada Pension Plan, since 1965. But for CPP and all private or employer-based insurers, the rules about medical records are regularly updated. New requirements are added regularly. That’s why it’s imperative to always maintain your own records in as detailed a manner as possible.

Why are claims denied by private, employer, and government insurers? Here are some of the most common reasons:

  • You’re under the age of 65: For CPP disability payments, you must be 65 or older to file a valid claim.
  • You haven’t contributed enough: You need to have worked long enough to contribute a minimum amount into the CPP plan.
  • Your disability must be classified as both “prolonged” and “severe” for CPP claims. This is the part of CPP claims where applicants are often
  • denied due to insufficient medical records.
  • Your condition does not meet the definition of “disability” according to your private insurance policy.
  • Your condition is not covered by your privacy policy.
  • The private insurer denies the claim due to inadequate medical records.

Getting Legal Help

Keeping accurate, legally sufficient medical records is a challenging task. On top of that, you need to know how and when to file a successful claim. Especially if you have been denied disability in Ontario, it’s important to hire a lawyer to resubmit a claim. Yes, many people “go it alone” and attempt to try again and again when their first, second, or third attempts to get disability are turned down. Hiring a competent lawyer who has experience with CPP and private disability claims is a much wiser approach and improves your chances for success.

Even before calling a lawyer, it can be helpful to study the official CPP website where all the rules are listed pertaining to how to file and what kinds of documentation you need to make a successful claim.

Disclaimer: The content of this article is a general guideline made available for educational purposes only and is not intended to be used as legal advice for the reader’s specific situation nor in general. By reading our blog and website content, the reader acknowledges the above and understands there is no lawyer-client relationship created between you and Himelfarb Proszanski through this content. To get specific legal advice, we encourage you to book a free consultation with one of our lawyers to clarify the legal aspects of your situation.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

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Sherene AlySherene Aly
16:02 23 Mar 24
I was very pleased with my decision to retain David and his team for my case. Melissa Gizzo was simply amazing and was able to secure a fair settlement for me.
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17:46 16 Feb 24
Experienced and excellent law firm. Their lawyers are wonderful, articulate, dilligent, amicable, calm, respectful, responsible, resourceful and have good human and customer relationships Especially DAN HOLLAND 👌 He is an amazing lawyer as regards dealing with any of the Accident case.I was involvedIn an accident in 2019 February. He was God sent as he dutifully and relentlessly worked hard until the case was settled
LizLiz
22:43 18 Jan 24
I highly recommend Dan Holland as a disability lawyer. His commitment to my case made the process seamless. Dan's clear communication and ability to simplify complex legal matters made it easy for me to understand every step. He demonstrated genuine concern for my best interests, making him not only a skilled attorney but also someone easy to talk to.Dan’s support extended beyond legal expertise; he alleviated my stress during the long-term disability case. His calm approach and unhurried demeanour ensured that there was no rush in our collaboration. This, coupled with his dedication, made the entire experience more manageable, fostering confidence in his ability to handle the case with meticulous care.I wholeheartedly endorse Dan for anyone seeking a lawyer who not only gets results but also prioritizes your peace of mind.
Neeshanth SritharanNeeshanth Sritharan
21:49 01 Jan 24
My mom was involved in an accident impacting her daily life and ability to work. Dan Holland has worked with us during the duration of our case and has been helpful in fighting for her and supporting us, and organizing the things we needed. Our family is incredibly grateful of the outcome Dan was able to obtain for us. I would highly recommend him!
Faiza HamidFaiza Hamid
01:26 22 Dec 23
I'm so happy I chose Mena Brar and her team represet us . We could not ask for a better team she is so kind, loyal, and honest. she spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. I appreciate you. Did it for me and how this will help me get back on track with my life. keep helping others. You are doing amazing works, Mena Brar. I wish you all the best.
Brenda FurtadoBrenda Furtado
23:38 12 Dec 23
Many thanks to Silene Malhao for settling my husband's TORT claim and to Mena Brar for settling his accident benefits claim. These ladies made themselves available any time we had a question. They were very understanding and compassionate. We were completely taken care of throughout this process. We would definitely recommend this team to friends and family!
ShaunaShauna
15:52 06 Dec 23
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Andrew CoutoAndrew Couto
23:10 21 Nov 23
I'm so happy I chose David as my lawyer. I spoke to a few lawyers before finding David and I noticed majority of them spoke to me in a way that felt demeaning or that my case wasn't big enough or important enough to take. One phone call with David and my opinion on lawyers changed. He spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. The whole process was wonderful. From dealing with David's law clerk Ingrid whom is an amazing and kind woman to his legal assistant Melissa whom is another amazing kind and talented young woman. I was so stressed about this case but from day 1 they helped ease that stress and always answered all my questions promptly and respectfully. I couldn't believe David got me to mediation within 6 months of being cut off my LTD and got me a settlement way beyond my expectations. I can't say enough good things about this law firm but I guarantee you that if you need a lawyer to fight for you David is your guy! . Believe me when I say this is the law firm for anyone dealing with personal injuries especially LTD denial claims. Thank you so much to David, Ingrid and Melissa you truly don't know how much I appreciate all you did for me and how this will help me get back on track with my life. Keep helping others you guys are doing amazing work! I wish you all the best!
Rose RegazziRose Regazzi
21:15 11 Oct 23
I sustained a relatively painful injury, affecting me long term.I wouldn't otherwise had pursued it, as it involved a relatively large corporation, but felt it necessary to do so. However, many lawyers were daunted, with one, who actually referred me to HIMPRO.I was connected with Dan Holland, who reviewed the case, provided with me realistic expectations, sound advice and had a willingness to move forward and represent me.His calm and professional demeanor, brought me to a place of reassurance. His ease in addressing all facets of this process, clearly demonstrated a wealth of experience. There was never any hesitation, when being challenged, and felt my best interest was always in the forefront.This case has since been resolved, to my complete satisfaction.Without reservation, HIMPRO (and Dan Holland, in particular), would be the only firm I would recommend for these type of cases.
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