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what to do if your long-term disability claim is denied based on a technicality
3 minute read
it is important to know that technical mistakes do not necessarily have to derail or negate your claim, and an insurer’s denial on that basis may not be the final word on the matter.
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do you fear your long-term disability claim has been denied due to a small technicality?
you could be right. it happens frequently!
in many cases, disability insurance companies will attempt to sidestep any assessment of a person’s ability to work, seizing instead on “technicalities” to deny an injured worker’s claim based on deficiencies in their application.
being forced off work because of a disability is typically one of the most stressful times in a person’s life — especially for those with a psychological aspect to their injuries. and while sympathetic observers may be inclined to excuse an injured worker for missing deadlines or omitting crucial information in this context, ltd applicants sadly cannot expect the same kind of compassion from their insurer.
the canadian life & health insurance association reports that 90 per cent of health insurance in canada is purchased through a group plan — so, of course, you should check carefully all requirements of your plan as you fill out your claim application.
however, it is important to know that technical mistakes do not necessarily have to derail or negate your claim, and an insurer’s denial on that basis may not be the final word on the matter.
here’s a cautionary — and compelling — tale of an actual client. he was a former professional athlete in his 40s, whose ltd claim denial had nothing to do with his insurer’s view of his ability, but was based purely on the late filing of his application for benefits.
the client overcame a difficult childhood, touched by tragedy, to make a name for himself in the competitive world of professional sports. after his retirement, he quickly established himself again in a new realm, working as an account representative for a business.
over time, he struggled with anxiety and depression, compounded by an alcohol use disorder as he carried out his work duties, which required a great deal of concentration and communication with various parties. by 2020, he stopped working as a result.
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overwhelmed by his mental health issues, he missed the deadline to apply for benefits by one year, which was set out in his ltd group policy. rather than insisting on a medical assessment, the insurer simply denied the man’s claim based on the lateness of his application.
instead of opting to engage in the internal appeal process of the insurer, (usually a frustrating waste of time, as ltd providers rarely find fault with their original decisions), he sought the help of our disability firm.
we moved quickly to sue his insurer, obtained his existing medical records and scheduled an appointment with a renowned psychologist, who ultimately concluded that his diagnosed conditions made it impossible for him to perform the essential tasks of his occupation.
as a result of our evidence gathering and negotiations, we reached an agreement with his insurer for a six-figure sum to resolve the matter that will allow him to concentrate on his health and recovery without worrying about dealing with his insurer any longer.
his case is a powerful reminder that insurance companies will not hesitate to issue a denial based on technicalities, regardless of how deserving an applicant’s claim is. but with some help, you can fight back.
nainesh kotak, is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he also serves as the chair of the long-term disability section of the ontario trial lawyers’ association.
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