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Why Do Insurance Companies Deny Claims for Disability Benefits?

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Why Do Insurance Companies Deny Claims for Disability Benefits?

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.

After an accident in which you suffer serious and permanent injuries, you may be eligible for long-term disability benefits from your insurance company (“insurer”), which provide you with a portion of your income when you become disabled. In order to assess your need for a certain benefit, your insurer will require documentation describing the injuries you have sustained as a result of the accident. Your lawyer will assist you in gathering, completing, and submitting the required documentation on time.

An insurance company may deny your long-term disability claim for a variety of reasons. Some of these might have a simple solution, such as making sure that the insurer has all of the necessary forms and documentation. In other cases, it might require the assistance of a disability lawyer to help you in your claim against the insurer in order to get the benefits that you are entitled to. For example, more complex issues may arise if you are not examined by insurance company-approved doctors, the time limitation in submitting a claim has expired, there was a misrepresentation on your application related to a pre-existing medical condition, the insurer has surveillance evidence that contradicts your claim, or there was a failure to have your injury or condition properly documented by your physician.

Generally, you will qualify for long-term disability insurance benefits if you are not able to do all, or substantially all, of the elements of your current job. A common reason that a disability insurance company will deny a long-term disability claim is for the reason that there are no “restrictions or limitations”. In short, this means your insurer has determined that the disability you are suffering from, and its associated symptoms, are not severe enough so as to prevent you from being able to work in your own job. Many long-term disability insurance policies indicate that in order to qualify for long-term disability insurance benefits, you will have to prove that not only can you not do your own job, but at some point down the road, you cannot do any job that you may be qualified to do by reason of your education, training, or experience.

Disability insurance companies often deny legitimate claims on grounds that there is a lack of objective evidence of disability and/or insufficient medical information. For instance, if the symptoms you are suffering are more subjective in nature or are “self-reported” and the insurer does not accept the claim as your symptoms cannot be proven objectively. However, the insurer’s position may be unfounded and incorrect from a legal standpoint. Perhaps you are suffering from an illness like Fibromyalgia that causes complete pain throughout your body, or from severe depression and anxiety – disorders that are more difficult to prove objectively. An insurance company will often rely upon the opinion of its own internal medical experts to decide on whether there is sufficient objective evidence of a disability. However, these professionals often only conduct a paper review and do not examine or even speak with the claimant. Even if the insurance company has initially approved your claim, they will too often cut off your benefits prematurely. This may be a result of the insurer claiming that you can work in some type of other type of job.

The insurance benefits process can be complex, with many eligible policy holders being rejected on their initial request for benefits – discouraging many people in need from obtaining the benefits they require. Utilizing the services of a disability lawyer immediately after your accident will help ensure your disability benefits claim is properly submitted and approved. A lawyer can assess your insurance policy and your injuries to collect all of the necessary documentation to strengthen your claim, such as obtaining proper medical evidence to submit to your insurer.

For more information, visit our disability lawyer section. If you have any questions, book a free consultation or call 1-855-446-7765 for immediate assistance.

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.

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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.

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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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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
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Faiza HamidFaiza Hamid
01:26 22 Dec 23
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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!
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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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Toronto Disability Lawyers
480 University Ave
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Toronto ON
M5G 1V2
(416) 599-8080

Brampton Disability Lawyers
2 County Ct Blvd
Suite 400
Brampton ON
L6W 3W8
(905) 595-6760

Hamilton Disability Lawyers
1 Hunter St E
Ground Floor
Hamilton ON
L8N 3W1
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Kitchener Disability Lawyers
22 Frederick St
7th Floor
Kitchener ON
N2H 6M6
(519) 772-7659

Oshawa Disability Lawyers
21 Simcoe St S
Oshawa ON
L1H 4G1
(289) 634-5554

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