One call Canadians never want to receive from their insurance company is that their long-term disability (LTD) claim has been denied.
For many of our clients who couldn’t work due to an illness or permanent injury, having their LTD claim turned down was an extremely stressful experience. They weren’t sure how they were going to support themselves or loved ones financially without access to disability benefits.
If your insurer tells you over the phone that your LTD claim has been denied, remain calm. In our experience, insurance companies usually don’t have a legitimate reason for doing so.
While your insurer’s argument might sound convincing, don’t hang up before asking them to provide you with the reasons for the decision in writing. This is known as a denial letter.
Here are the top four reasons you need to get a denial letter from your insurance company after your LTD claim has been turned down.
1. It makes it difficult for your insurer to change their rationale at a later date
Denial letters force insurance companies to “lock in” their reasons for rejecting an individual’s LTD claim – making it difficult for them to pivot to a completely different explanation down the road.
In some cases, this document can indicate bias or a lack of due diligence on the insurer’s part.
READ MORE: Most common mistakes people make when they are denied long-term disability
If your insurance company didn’t have a legitimate reason for denying you access to disability benefits, the denial letter will highlight the mistakes that were made when handling your claim.
2. It helps your doctor address any issues that your insurer has with your claim
When applying for LTD benefits, your insurance company will require your treating doctor to submit a physician statement. This document should clearly explain why you can’t work due to your disability.
However, it’s not uncommon for insurers to disagree with, or even dismiss, the assessment provided by a claimant’s doctor.
In many cases, LTD claims are hastily turned down because the insurance company’s medical consultant doesn’t believe that an individual qualifies for disability benefits.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
Providing your physician with a denial letter allows them to review the insurer’s rationale and reiterate in writing why your disability prevents you from working.
3. It informs you of your right to pursue a legal claim
From a legal standpoint, a denial letter is usually the first formal moment that an insurance company has breached its obligations – aside from not paying you.
In addition to explaining why your LTD claim was rejected, this document generally addresses the appeals process and the two-year limitation period within which you can pursue a legal claim.
READ MORE: 3 reasons you shouldn’t appeal a denied long-term disability claim
If you don’t get your insurer’s decision in writing, it can be difficult to confirm that you have been denied access to disability benefits.
4. It’s something we need in order to assist you
Don’t be afraid to ask your insurance company for a denial letter. It’s an essential step that can help you get the compensation you deserve.
As soon as you receive your insurer’s decision in writing, contact an experienced disability lawyer at Samfiru Tumarkin LLP. It’s very important that you get the right legal advice before appealing the insurance company’s decision.
Our compassionate team regularly resolves LTD, life insurance, critical illness and mortgage insurance claim denials across Canada.
We provide free consultations 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: What to expect when hiring a lawyer to fight your disability claim denial
An interesting case that our firm recently handled involved an accountant struggling with chronic back pain.
Roughly a week after applying for LTD benefits, his insurer informed him over the phone that his claim had been denied.
When he asked why his application had been turned down, his insurance company told him that their medical consultant reviewed his file and determined that he didn’t qualify for disability benefits.
However, the employee’s treating doctor specifically noted in their physician statement that his back pain 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 his insurer’s decision in writing, he reached out to Samfiru Tumarkin LLP.
As our lawyers reviewed the denial letter and the physician statement, 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 accountant’s insurer, we were able to secure an extremely favourable amount of compensation for the employee.
Denied long-term disability? 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.