Chronic back pain, particularly lower back pain, is one of the most challenging injuries to navigate.
In some cases, it’s nearly impossible for individuals to continue working – even with a significant amount of medication to ease the pain.
Despite this, insurance companies in Canada often deny legitimate long-term disability (LTD) claims for back pain.
One excuse commonly used by insurers to prevent claimants from accessing disability benefits is that they don’t meet the definition of “totally disabled” under their LTD policy.
READ MORE: 4 reasons why long-term disability claims are rejected
For many of our clients, having their claim turned down created a substantial amount of mental and financial distress. Without access to LTD benefits, they weren’t sure how they were going to pay bills or put food on the table during their recovery.
If your insurance company has rejected your claim for back pain, don’t panic. Here are three things you need to do.
1. Confirm the reasons for the denial in writing
Once you have been denied LTD benefits, it’s very likely that your insurer will send you a letter – informing you of their decision.
Unfortunately, denial letters are usually vague and don’t provide many details about why your claim was turned down.
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After reviewing the denial letter, ask your insurance company to schedule 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.
READ MORE: Most common mistakes people make when they are denied LTD
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.
Shortly after the conversation, send your insurer an email that summarizes what was said during the call. 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.
READ MORE: Long-term disability insurance adjuster behaving badly? 4 things to do
2. Talk to your doctor
After speaking with the claims handler assigned to your case, bring your notes from the phone call and your denial letter to your treating doctor. Ask them if they agree with the 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 back pain. Depending on the extent of your injury, this could be your physician or an orthopedic surgeon.
When applying for LTD benefits, your insurer will require your treating doctor to submit a physician statement. This document should clearly explain why you can’t work due to your back pain.
In the event that your claim is denied shortly after submitting it, ask your doctor to reiterate 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 claim was initially approved by your insurance company, there is a chance that it could be denied at the “change of definition” date. This is usually after LTD benefits have been paid for two years.
In this situation, it’s crucial that the medical professional providing primary care for your back pain clearly outlines in writing why it prevents you from doing any job.
If your insurer provides a list of potential roles that you are qualified for, make sure your treating doctor explains why you wouldn’t be able to fulfill the needs of each position due to your condition.
3. Contact us
Chronic back pain can have a significant impact on an individual’s physical, mental and financial health.
If you are denied or cut off from disability benefits for any reason, contact an experienced disability lawyer at Samfiru Tumarkin LLP before appealing the insurance company’s decision.
For many of our clients, filing a claim is a new experience. As a result, they are unaware of the specific rights they have when insurers reject their application or prematurely close their case.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
We regularly resolve LTD, life insurance, critical illness and mortgage insurance claim denials across Canada.
Our lawyers know the law and have helped numerous clients, including Sandra Bullock and Julie Austin, hold insurance companies accountable after their claims were turned down or cut off prematurely.
We provide free consultations and don’t get paid unless we secure the compensation from your insurer that you are legally entitled to.
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 can help individuals anywhere in Canada (except Quebec). Get the advice you need and the compensation you deserve.
Sivan Tumarkin and James Fireman 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 free advice on Canada’s only Disability Law Show on TV and radio.