Long Term Disability Lawyer Hamilton

Denial of a Disability Insurance Claim

Have you ever had a claim for disability insurance denied? We are a Hamilton-based disability insurance denial attorney representing clients throughout southern Ontario. A handicap, whether sudden or degenerative, might result in you losing your job and being unable to pay your bills. It’s a frightening and sometimes frustrating situation, and most individuals — if they have insurance — turn to their disability insurance plans for hope and assistance. It may appear that filing an insurance claim is simple, but this is not always the case.


Can Disability Insurance Be Denied?

Long-term disability (LTD) claims and short-term disability claims are sometimes refused unfairly by insurance companies based on minor technicalities. Continue reading to understand how a long-term disability insurance rejection attorney can assist you.

Why was my claim for disability denied?

Your disability claim might have been dismissed for a variety of reasons. For example, it’s possible that the claim did not contain all of the requisite medical paperwork or that the injury/illness did not match certain policy conditions. Sometimes claims are refused because the claimant missed a deadline. Let’s face it: applying for disability benefits may be lengthy and complicated.

Lack of objective evidence: Disability claims are sometimes denied because there are no factual findings to back them up. This signifies that the reviewer does not have hard facts to back up a physical or mental health diagnosis, such as x-rays, lab findings, MRIs, or another medical testing. Even though your insurance policy does not require it, a claims reviewer may consider a lack of objective proof as a cause to deny your claim. In such a scenario, you may need the assistance of an attorney who has previously dealt with refused disability cases. Some insurance firms have been known to seek “objective evidence” even when the policy does not explicitly state that it is required.

Pre-existing conditions: Some insurers will try to deny a claim based on an illness or symptoms before your coverage goes into force. They may, for example, explain the rejection by presenting proof that you had treatment within a period of exclusion specified in your insurance. They may also reject claims if the reviewer determines that you should have sought appropriate treatment for a problem that has not been addressed. However, because this is a reasonable basis for rejection in many policies does not guarantee that your claim is correctly classified in this category, and such denials should be investigated further.

Change in the plan’s definition of disability: In many policies, insurers exploit a preset change in the description of disability over time to provide an easy way out of paying benefits to otherwise qualified. Most LTD insurance plans, for example, contain a time limit on how long a claimant may be paid if they cannot fulfill their usual job duties. The insurance provider will only continue to give coverage if you cannot work in any vocation after this predefined period — generally two years — has passed.

Inadequate medical treatment: Most rules mandate that those receiving disability payments continue to get medical treatment, but there is a catch. If your policy does not specify “continuing care,” although it is required, the insurance company can always claim you are not receiving adequate ongoing care. In addition, in rare situations, insurers may refuse to accept particular types of doctors or make suggestions for care that they would later use to deny a claim.

Insurance firms frequently hire private investigators to observe, follow, photograph, and video someone who has filed a large claim. To determine if your claim is fake, they may interview your neighbors, previous coworkers, and other persons you routinely deal with. If you are honest with the insurance company and your physicians, you have nothing to fear from their surveillance. Remember that having a handicap does not imply that life comes to a halt; in fact, over 40% of Canadians aged 15 and up with a disability are regarded to have a “moderate” condition.

Am I Eligible for Disability Benefits?

Suppose you have an LTD policy via your employer or a private policy because you’re self-employed. In that case, there are a few items you should look through in your insurance contract to ensure you’re covered under your policy and current circumstances. One of many ‘tests’ in your policy will decide if you are qualified for disability insurance coverage:

The “Own Occupation” test determines whether or not you are eligible for benefits if you cannot return to the same employment you had before your accident or the commencement of your disability. Insurance that includes this test and has no time restriction on how long it applies is likely to be the most expensive, but it may be the best policy for individuals with specialized occupations. Many people unable to function in their technical vocations are forced to work in other fields, resulting in a significant wage drop.

Percentage test: This definition specifies a percentage of your responsibilities that you cannot do, deeming you handicapped. For example, you are termed incapacitated if you can no longer do 65 percent of your previous duties.

The “Any Occupation” test is the most stringent qualifying criteria. It indicates that your injuries are severe enough that you cannot work in any occupation for which you are adequately qualified, based on your experience, education, training, and remuneration.

How Do I Fight an Insurance Claim Denial?

Suppose you have an LTD policy via your employer or a private policy because you’re self-employed. In that case, there are a few items you should look through in your insurance contract to ensure you’re covered under your policy and current circumstances. One of many ‘tests’ in your policy will decide if you are qualified for disability insurance coverage:

In the insurance sector, being denied disability insurance coverage is quite frequent. Here’s what you can do if you’ve received a refusal letter.

Keep your denial letter in a secure location. This is an essential document because it will indicate the letter’s date, which is the start of the two-year limitation period for filing a lawsuit in Ontario. In addition, the definition of “disability” as defined by your policy, the policy’s terms, the insurer’s grounds for refusing your benefits, and, in some situations, the last day of your long-term disability payments are all included in the rejection.

Avoid the internal appeals process: winning an internal appeal is extremely tough. In other words, someone from the same firm that previously refused you is evaluating a decision made by a coworker. It might be tough to win an appeal unless you have brand-new facts or medical reports to offer that the insurer did not previously know. It can happen, but it’s extremely tough, which is why many individuals hire a disability attorney.

Read your company’s policy or the policy pamphlet supplied to you. Although some of the material may be tough to comprehend, being well-informed can benefit you. Look for anything that jumps out to you, and develop a list of any questions you can ask a long-term disability insurance attorney when you contact them.

Keep an eye on the clock. These might be insurance company deadlines for supplying further information for your claim or taking legal action. If you’re unsure about these deadlines, ask. If your LTD benefits have been refused or terminated, you should contact an attorney with experience managing LTD claims as soon as possible before making any decisions concerning your claim.

Call a disability lawyer: As soon as you receive your refusal notice, contact a personal injury lawyer in Ontario specializing in long-term disability insurance. Even if you’re very sure you understand why you were denied, things might get confusing. For example, your insurance may contain rehabilitative care standards stated in dense legal language that you thought you were following but didn’t due to understandable misunderstanding. It might be beneficial to have someone on your side who is looking for insurance company trickery.

Continue to see your doctor: Request that they update your medical records. To support your disability claim, you’ll need to keep track of your medical records, and your doctor may refer you to experts. These experts can assist diagnose your disease, providing treatment choices, and, if necessary, testify as expert witnesses in your case.

Conversations should be written down. Even if you merely write yourself a quick email with a summary of a doctor’s appointment or a phone conversation from the insurance company — which, hopefully, will be handled by your lawyer from this point on — make sure to document dates, times, individuals, and relevant information.

How Do I Write an Appeal Letter for Long-Term Disability Denial?

You may always appeal your refusal to the insurance company directly, but hiring a lawyer can help you save time in getting back on track. Avoid the internal appeals procedure; it’s extremely tough to succeed because someone from the same firm reviews a coworker’s earlier decision. In addition, it might be tough to win an appeal unless you have brand new facts or medical reports to submit that the insurer does not already know. It happens but is extremely tough, which is why many individuals hire a disability attorney.

You don’t even have to wait until your LTD claim is dismissed for obtaining legal assistance. However, even if you haven’t been refused yet, you may feel that collecting benefits under your long-term disability plan is becoming more complex. To establish the most extraordinary claim possible, hiring a lawyer may assist you in staying on top of your deadlines, documentation, and other eligibility criteria.

How Can a Long-Term Disability Insurance Lawyer Near Me Help?

Disability lawyer Hamilton will assist you with your claim for long-term disability compensation. Insurance companies and long-term disability policies in Canada might be challenging to understand on your own, so our staff is ready to take all possible means to expedite your claim and obtain appropriate compensation for you. We are dedicated legal specialists that have aided numerous people in Ontario to obtain just settlements. We’d be pleased to talk with you about our tactics to get insurance companies to approve our appeals. Disability claims aren’t without hope.

Personal injury law differs from other forms of litigation in that we only get paid if your injury damages are reimbursed. This fee structure is known as a contingency fee, and many personal injury lawyers use it. This is a positive thing in general. For starters, any lawyer who accepts your case is confident in their ability to establish a compelling case. It also implies that if your claim isn’t as successful as you planned, you won’t owe any money to your total permanent disability insurance lawyer. However, it would help if you considered legal expenses when calculating the ultimate settlement amount you might anticipate receiving. Therefore, it’s crucial to understand the contingency fee procedure, and you should question every lawyer you contact about their fee arrangements.

My business solely handles personal injury cases and represents individuals seeking long-term disability benefits. We give straightforward legal advice to assist customers in recovering just compensation with no upfront costs. To book a free consultation, call 855-769-0418 or contact us online.

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22 Wilson St, Hamilton, ON L8R 1C5, Canada


+1 221-431-8294