For many Canadians, arthritis can have a profound impact on their ability to perform everyday tasks.
In some cases, it’s nearly impossible for individuals to continue working – even with a significant amount of medication.
Despite this, insurance companies often deny legitimate long-term disability (LTD) claims for arthritis.
One excuse frequently used by insurers to prevent claimants from accessing disability benefits is that they don’t meet the definition of “totally disabled” under their policy.
If your insurance company turned down your LTD claim for arthritis, remain calm. Here are three things you need to do.
1. Get your insurer’s reasons for the denial in writing
In our experience, it’s not uncommon for insurance companies to tell individuals over the phone that their LTD claim has been rejected.
If you are informed of the decision verbally, ask your insurer to provide you with their rationale in writing. This is known as a denial letter.
READ MORE: Denied long-term disability? 4 reasons to get your insurer’s decision in writing
Once you have reviewed the document, contact your insurance company and request a phone call with the claims handler that was assigned to your case. It’s crucial that there is a written record of this conversation.
As you discuss the reasons for the denial over the phone, take notes. If you need the claims handler to slow down or repeat something, don’t hesitate to ask.
Following the call, send your insurer an email that summarizes what was said. It doesn’t have to be word for word – you are looking to confirm the substance of what was discussed.
If the claims handler doesn’t respond to your email or suggest that something you noted was incorrect, this will be considered an accurate record of the conversation.
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2. Talk to your doctor
After speaking with the claims handler that was assigned to your case, bring your notes from the phone call and the denial letter to your treating doctor. Ask them if they agree with your insurance company’s decision to turn down your LTD claim.
If you are receiving treatment from several medical professionals, this information should be given to the doctor providing primary care for your arthritis.
In the event that your physician disagrees with the insurer’s decision, have them explain in writing why your condition prevents you from resuming your job duties.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
If your LTD claim was initially approved by your insurance company, it’s possible that it could be rejected at the “change of definition” date. This usually occurs after you have received disability benefits for two years.
In this situation, it’s very important that the medical professional providing primary care for your arthritis clearly outlines in writing why it prevents you from doing any job.
If your insurer sends you a list of potential roles that you are qualified for, ask your treating doctor to review it. Make sure that their report explains why you wouldn’t be able to fulfill the needs of each position, or would be limited in doing so, due to your condition.
3. Contact us
For many of our clients, having their legitimate LTD claim turned down created a substantial amount of mental and financial distress. They weren’t sure how they were going to pay bills or put food on the table without access to disability benefits.
If you are denied or cut off LTD for any reason, contact an experienced disability lawyer at Samfiru Tumarkin LLP. It’s crucial that you get the right legal advice before appealing your insurance company’s decision.
Our compassionate team regularly resolves issues involving LTD, short-term disability, life insurance, critical illness and mortgage insurance claims across Canada.
We provide consultations at no cost to you and don’t get paid unless we get results. Over the years, we have helped thousands of Canadians, including Sandra Bullock and Julie Austin, secure the compensation that they are legally entitled to.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
An interesting case that our firm recently handled involved an office clerk who was struggling with rheumatoid arthritis.
Two weeks after applying for LTD benefits, his insurer informed him over the phone that his claim had been rejected.
When he asked why his application had been turned down, his insurance company told him that their medical consultant didn’t believe he was disabled.
However, the employee had full support from his treating doctors. In their reports, they specifically noted that his condition prevented him from doing any work – even on an hourly basis.
Confident that he had a strong case, he requested a denial letter before ending the call. Once he received the document from his insurer, he reached out to Samfiru Tumarkin LLP.
As our lawyers reviewed the denial letter and the reports from the employee’s treating doctors, it quickly became clear that the insurance company’s medical consultant didn’t do a comprehensive review of the file.
READ MORE: The insurer cut off his benefits. Then his lawyer reviewed his medical assessment
After bringing our findings to the office clerk’s insurer, we were able to secure an extremely favourable amount of compensation for the worker.
Long-term disability claim denied? Asked if you want to appeal the insurance company’s decision?
Contact the firm or call 1-855-821-5900 for a free consultation with a disability lawyer. We help Canadians across all provinces (excluding Quebec). Get the advice you need and the compensation you deserve.
Sivan Tumarkin and Albert Klein are disability lawyers at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in employment law and long-term disability claims. The firm provides legal insight on Canada’s only Disability Law Show on TV and radio.