Common Mistakes made on Disability Claims Applications

Posted by Stevenson Whelton MacDonald & Swan
November 01, 2018

Disability coverage provides needed financial protection when an illness or injury prevents you from working.  Many Canadians rely on disability benefits for income replacement at some point in their lifetime.  Long-term disability (LTD) benefits are available to many Canadians through their employer, but someone without workplace coverage, such as a self-employed person, can purchase their own LTD coverage.

Long-term disability benefits generally pay 60 to 70% of a person’s income. To be eligible for benefits, you must show that you are unable to perform the essential tasks of your own, or any, occupation, depending on the wording of your specific LTD plan.  Most group or employer-provided plans are based on the ‘own occupation’ requirement for the first 2 years of coverage, and then change to the ‘any occupation’ requirement.

However, sometimes a disability claim is rejected for persons who are genuinely disabled, according to the provisions of their disability plan. Some of these issues can be effectively addressed and successfully fought with the help of an experienced disability lawyer. Here are some of the most common reasons why your claim may be denied.

  1. You missed the timeline for filing a disability claim or for appealing a denied claim.
  2. You did not receive a diagnosis by a physician with expertise in your medical condition.  For example, if you are disabled due to a mental condition such as depression or anxiety, you need to be diagnosed by a psychiatrist or psychologist.
  3. You are not receiving regular medical care from a physician on an ongoing basis, such as every two weeks or monthly.  
  4. You have not been following your physician’s advice and recommendations for treatment, including taking prescribed medications, and therefore, you failed to mitigate your symptoms.
  5. On the medical portion of your application, your physician did not include all the required information, such as specific details indicating how your symptoms prevent you from performing essential tasks in your work.
  6. You failed to include other important information on your application.
  7.  The insurance company's medical experts have reason to believe that the care you are receiving from your doctors is substandard and that is why your health is not improving.
  8. You misrepresented information on your application or exaggerated your disability.
  9. Your employer failed to provide necessary documentation to the insurer, such as details for all the required tasks of your current job.
  10. After being eligible for, and receiving, LTD benefits for 2 years based on the ‘own occupation’ definition, your insurer finds that you are no longer eligible since you have not provided medical proof that you cannot perform ‘any occupation’ for which you are reasonably suited.
  11. Your insurer believes that you are not ‘totally disabled’ from working as you can work on a modified basis or part-time.

The key actions that will lead to a successful disability claim include: being under the regular care of your physician; following the treatment advice of an appropriate and competent medical professional; providing the required information on your LTD application; and being honest and forthright about your disability.  However, if your disability claims was denied, you are far more likely to obtain owed benefits by getting the help of a knowledgeable disability claims lawyer at Stevenson Whelton MacDonald & Swan than by negotiating the insurance company’s ‘in house’ appeals process.  Call Stevenson Whelton MacDonald & Swan today and find out how we can help resolve your case as quickly as possible.

Disclaimer: Our blog is intended to inform our existing and prospective clients about topics pertinent to their lives. While our goal is to provide accurate and factual information, this in no way should be taken as legal advice or applied to specific cases. It is in your best interest to contact a licenced and practising lawyer for legal representation, as matters of the law are often complicated and cannot be fully assessed without knowing all of the details of a case.