Common Reasons for LTD Denials and How We Can Help
Insufficient Medical Evidence
Insurance companies often deny claims when they believe the medical documentation does not prove the severity of the condition or its impact on the claimant’s ability to work.
With Frank Van Dyke as your long-term disability lawyer, we can gather compelling medical documentation by helping to collect the following to build a case:
- Medical records
- Test results
- Expert opinions
Failure to Meet Insurance Policy Definitions
Insurance companies have strict definitions of what constitutes a disability, and these definitions can vary significantly between providers.
Specific policies may require you to be completely unable to perform any occupation, while others focus on your inability to perform your job. These strict definitions can result in claim denials, even when you cannot work due to a condition.
We play a vital role in challenging these unfair interpretations by reviewing the following:
- The policy’s language
- Inconsistencies or overly restrictive terms
- The insurer’s narrow definitions
As your LTD lawyer, we can advocate for a fair assessment, ensuring your claim is evaluated fairly and helping prevent insurance companies from minimizing payouts.
Missed Deadlines or Administrative Errors
Missed deadlines or administrative errors are among the most common yet avoidable reasons for claim denials. Minor mistakes or delays can result in a denial of benefits. Meanwhile, insurance companies impose strict timelines for:
- Submitting applications
- Filing appeals
- Providing additional documentation
As your long-term disability lawyer, we ensure that all deadlines are met and that paperwork is completed correctly and thoroughly. Our team can review every detail of your application or appeal, ensuring no errors jeopardize your claim.
Private Insurance (LTD) vs. CPP Long-Term Disability
Private insurance and CPP serve similar purposes in helping individuals receive financial support.
Private LTD insurance is offered through employers or purchased individually. It provides income replacement based on the policy’s terms for individuals with long-term disabilities.
CPP Disability Benefits (Canada Pension Plan Disability Benefits) is a government program designed to financially support individuals who cannot work due to a severe and prolonged disability. Eligibility is based on contributions to the CPP and the severity of the disability. CPP requirements include:
- You’re under 65
- Contributed the right amount to the Canada Pension Plan
- Have a mental or physical disability preventing you from working
- Have a long-term disability that could result in death
While CPP Disability Benefits can often work alongside private LTD benefits, according to the Government of Canada, your CPP payments could be reduced if you receive private LTD insurance.
We can help you navigate the CPP application process and help prevent denials by assisting with:
- Gathering medical and employment evidence
- Filling out paperwork
- Building a strong case for approval
How to Appeal a Denied Long-Term Disability Claim
Appealing a denied long-term disability (LTD) claim can feel daunting, but understanding the process and having the proper support can make all the difference. Here’s a step-by-step guide to help you navigate the appeal process:
- Review the Denial Letter: Carefully read the insurer’s denial letter to understand the reasons for the rejection, to be able to appeal those specific issues.
- Gather Additional Evidence: Collect all relevant and new evidence missing from the original claim. Any further evidence to support your claim can include colleagues or managers attesting to the inability to work, updates from medical professionals, and updated medical assessments.
- Submit a Written Statement: Prepare a statement regarding your claims and addressing new evidence to support each reason for the denial clearly and concisely.
- Meet Deadlines: Once your appeal is ready, submit it within the timeline.
With Van Dyke legal representation, you gain an advocate who can effectively challenge unfair denials. We ensure that your appeal is thorough, timely, and persuasive, giving you the best chance to secure the benefits you deserve. Moreover, where the insurance company denies the appeal, we can help find other alternatives, such as filing a lawsuit or pursuing alternative dispute resolution.
Why Choose Van Dyke Law for Long-Term Disability Claims?
Van Dyke Law stands out as a trusted and experienced advocate for individuals across Ontario. We have successfully represented countless clients in securing the benefits they deserve, backed by glowing client testimonials that highlight our commitment, expertise, and compassionate approach.
Contact Us for a Free Consultation
At Van Dyke Law, we provide free consultations, and our team is here to answer your questions, explain your options, and confidently guide you on a path forward. Contact us today.
Locations We Serve
Our main offices are located in Ottawa, Kingston, and Belleville, but we serve all of Southern Ontario, including Carleton Place, Pembroke, Perth, and the following locations:
Contact us today for more information regarding our services or to request a free, no-obligation consultation.
