A brain injury can change an individual’s life forever. In many cases, these injuries make it extremely difficult to continue working or spend quality time with loved ones.
Despite this, insurance companies in Canada often turn down legitimate long-term disability (LTD) claims for brain injuries.
A common excuse used by insurers to deny claimants access to disability benefits is that they don’t meet the definition of “totally disabled” under their LTD policy.
For many of our clients, being turned away by their insurance company created a significant amount of mental and financial distress. They had no idea how they were going to support themselves or their families without access to LTD benefits.
READ MORE: 3 things that can help reduce stress when dealing with a long-term disability insurer
If your insurer rejects your claim after a brain injury, don’t lose hope. Here are three things you need to do.
1. Get the denial in writing
In our experience, insurance companies often tell claimants that they have been denied LTD benefits over the phone.
If you are informed of the rejection verbally, ask your insurer to provide you with the reasons for their decision in writing. This is known as a denial letter.
While denial letters are usually vague, they can sometimes indicate bias or a lack of due diligence on the insurance company’s part.
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READ MORE: Most common mistakes people make when they are denied long-term disability
As soon as you receive your insurer’s decision in writing, contact an experienced disability lawyer at Samfiru Tumarkin LLP.
Once we are formally hired to represent you, we can use the law to get your insurance company to disclose every document relevant to your claim. This includes a copy of their file as well as your policy.
With this information, we can identify the mistakes your insurer made when handling your claim, assess your legal options and help you secure the compensation you deserve.
READ MORE: What to expect when hiring a lawyer to fight your disability claim denial
2. Talk to your doctor
When applying for LTD benefits, your insurer will require your treating doctor to submit a physician statement. This document should clearly outline why you can’t work due to your brain injury.
After your claim has been turned down, bring the denial letter to your doctor. Ask them if they agree with the insurance company’s decision.
If your physician disagrees, have them explain in writing why your brain injury prevents you from resuming your job duties.
In the event that you are receiving treatment from multiple medical professionals, ask each of them to also comment on your condition in a letter or email.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
One of the firm’s clients, an accountant, applied for disability benefits after she suffered a serious concussion during a car accident.
Roughly a week after submitting her claim, her insurer informed her over the phone that her application had been denied because her treating doctor didn’t clearly outline why she couldn’t work due to her injury.
Before ending the call, the accountant asked her insurance company to provide her with the rejection in writing. Once she received the denial letter, she immediately contacted Samfiru Tumarkin LLP.
When our lawyers reviewed the physician statement, it was clear that the individual’s doctor did explain why she couldn’t perform the duties of her job.
READ MORE: The insurer cut off his benefits. Then his lawyer reviewed his medical assessment
The report specifically noted that she suffered intense migraines when she looked at a computer for more than five minutes and was prone to fainting in high-stress situations.
After bringing our findings to the accountant’s insurer, we were able to secure proper compensation for the employee.
3. Contact us
A brain injury can severely affect an individual’s physical, mental and financial health. While some are able to recover, it can be permanently life-altering for others.
If you are denied or cut off from disability benefits for any reason, speak with an experienced disability lawyer at Samfiru Tumarkin LLP before appealing the insurance company’s decision.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
Our firm regularly resolves LTD, life insurance, critical illness and mortgage insurance claim denials across Canada.
We know the law and have helped numerous clients, including Julie Austin and Sandra Bullock, hold insurers accountable after their claims were turned down or cut off prematurely.
Our lawyers provide free consultations and don’t get paid unless we secure the compensation from your insurance company 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 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 free advice on Canada’s only Disability Law Show on TV and radio.