Lupus can dramatically affect an individual’s ability to perform everyday tasks – including their job duties.
For Canadians who can’t work due to this debilitating condition, long-term disability (LTD) benefits can provide a crucial financial lifeline.
Unfortunately, insurance companies often deny legitimate LTD claims in cases involving lupus.
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 rejected your claim for LTD benefits based on lupus, here are three things you need to do.
1. Confirm 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 turned down.
By informing claimants verbally, insurers are able to change their rationale in the event that the decision is challenged.
If this happened to you, contact your insurance company immediately and request a denial letter. This document will make it very difficult for them to pivot to a different explanation at a later date.
READ MORE: Invisible illnesses: Can I still get long-term disability even if I don’t look sick?
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As soon as you receive the denial letter from your insurer, connect with an experienced disability lawyer at Samfiru Tumarkin LLP. We can review your situation, assess your legal options and help you secure the compensation you deserve.
Even if you don’t have this document, it’s still in your best interest to contact our firm. We provide free consultations for issues involving LTD.
2. Discuss the denial with your treatment team
After receiving the denial letter from your insurance company, bring the document to the doctor providing primary care for your lupus. Ask them if they agree with the insurer’s decision.
If your physician disagrees, have them explain in writing why your condition prevents you from resuming your job duties.
The more supporting medical documentation you can provide, the better. If you are seeing other specialists or treatment providers, gather their opinions as well.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
In some cases, insurance companies cut individuals off LTD benefits on or around the “change of definition” date. This usually occurs two years after a claim was approved.
If this situation applies to you, make sure that the doctor providing primary care for your lupus clearly outlines in writing why it prevents you from doing any work – not just your own job.
3. Contact us
For many of our clients, having their legitimate LTD claim turned down was incredibly distressing. 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 insurer’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
A troubling case that our firm recently handled involved a groundskeeper who was struggling with lupus.
Three weeks after applying for LTD benefits, he received a letter from his insurance company – informing him that his claim had been rejected because he didn’t meet the definition of “totally disabled” under their policy.
Not sure what to do next, the groundskeeper decided to call Samfiru Tumarkin LLP for a free LTD consultation.
Confident that he had a strong case, we told him to get the denial letter reviewed by his treatment team.
The groundskeeper’s treating doctors were appalled by the insurer’s decision. They clearly outlined in writing why his condition prevented him from doing any work – even on an hourly basis.
READ MORE: The insurer cut off his benefits. Then his lawyer reviewed his medical assessment
With full support from the medical professionals involved in his care, he contacted us again.
Following conversations with the groundskeeper’s insurance company, we were able to secure an extremely favourable amount of compensation for our client.
Long-term disability claim denied? Asked if you want to appeal your insurer’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.