Heart diseases, such as coronary heart disease (CHD), can dramatically affect an individual’s ability to perform everyday tasks.
In some cases, it’s nearly impossible for Canadians to continue working or spend quality time with loved ones.
Despite this, insurance companies often deny legitimate long-term disability (LTD) claims for heart disease.
An 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.
For many of our clients, having their claim turned down was devastating. They weren’t sure how they were going to support themselves or their families financially without access to LTD benefits.
If your insurance company rejected your claim for heart disease, don’t lose hope. Here are three things you need to do.
1. Confirm your insurer’s reasons for the denial in writing
After you have been denied LTD benefits, there is a very good chance that your insurance company will send you a letter – informing you of their decision.
If you don’t receive a denial letter from your insurer, ask them to provide you with one as soon as possible.
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 very important 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 repeat something or slow down, let them know.
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Following the call, send your insurer an email that summarizes what was said. Don’t worry about it being word for word – the goal is 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. Speak with your doctor
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 heart disease.
After your claim has been turned down, bring the denial letter and your notes from the phone call with the claims handler to your physician. Ask them if they agree with the insurer’s decision.
If you are receiving treatment from several medical professionals, this information should be given to the doctor providing primary care for your heart disease. Depending on the extent of your condition, this could be your cardiologist.
In the event that your LTD claim is denied shortly after submitting the physician statement, ask your doctor to reiterate in writing why your heart disease 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, it’s possible that it could be rejected at the “change of definition” date. This usually occurs after you have received LTD benefits for two years.
In this situation, it’s crucial that the medical professional providing primary care for your heart disease clearly outlines in writing why it prevents you from doing any job.
If your insurer provides you with a list of potential roles that you are qualified for, have your treating doctor review it. Make sure 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 Canadians, applying for LTD benefits is a new experience. As a result, they are unaware of the specific rights they have when their insurance company rejects their claim or prematurely closes their case.
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 insurer’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 clients, 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 a mechanic struggling with CHD.
A few weeks after applying for LTD benefits, her insurance company informed her over the phone that her claim had been denied.
When she asked why her application had been rejected, her insurer told her that their medical consultant didn’t believe she was disabled.
However, the employee’s treating doctor specifically noted in their physician statement that her condition prevented her from doing any work – even on a part-time basis.
Confident that she had a strong case, she requested a denial letter before ending the call. Once she received her insurance company’s decision in writing, she reached out to Samfiru Tumarkin LLP.
As our lawyers reviewed the denial letter and the physician statement, it quickly became clear that the insurer’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 mechanic’s insurance company, we were able to secure an extremely favourable amount of compensation for the employee.
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.