Disability News

Common Mistakes Leading to Disability Claim Denials and How to Avoid Them

When you’re faced with a disabling injury or illness, the last thing you need is the added stress of a denied disability claim. As Hamilton long-term disability lawyers, we’ve seen firsthand how devastating it can be when people are unable to access the benefits they desperately need to maintain their quality of life. The truth is that disability claims are often denied for a variety of reasons – many unfair and many avoidable. Many feel overwhelmed, frustrated, and unsure where to turn for help.

Here, we will review some of the most common pitfalls that can lead to a denied disability claim and provide valuable insights to help you navigate the complex world of disability insurance. Whether you’re filing a claim or have recently received a denial, understanding these potential obstacles can make all the difference in securing the benefits you deserve. 

If you have any questions or want help with your application, call us anytime at  1-844-4-DISABILITY for a free consultation. 

Why do Long-Term Disability Benefits Claims get Denied?

While mistakes and oversights on behalf of a claimant can very well lead to a claim denial, it’s also important to remember that insurance companies are not on your side. Often, they will do whatever they can to downplay your situation, coerce you into a low settlement, and generally try to justify the lowest payment possible.  

This is why it’s crucial to work with an experienced Hamilton long-term disability lawyer. This helps you build the strongest case possible and avoid any mistakes. Filing a long-term disability claim is a long and arduous process with many nuances and moving parts. Navigating it alone feels impossible for many individuals. 

Some of the most common reasons for long-term disability benefits denial include:

1. Failure to Meet the Definition of Disability

This is one of the most common reasons insurance companies deny long-term disability claims. To receive disability benefits, you must meet their definition of “total disability” as set out in your long-term disability policy, which is typically set out in two phases – the “own occupation” definition or the “any occupation” definition. 

To satisfy the definition in terms of one’s own occupation, you must be deemed unable to perform your job’s essential tasks and substantial duties, even with reasonable accommodations.

What are some examples of “Total Disability” under the “Own Occupation” definition?

• A factory worker who sustains a severe back injury, rendering them completely unable to perform physical tasks and labour;
• A commercial electrician with the onset of epilepsy;
• A surgeon develops severe hand tremors due to Parkinson’s disease, making it impossible to perform delicate surgical procedures;
• A plumber with severe rheumatoid arthritis, causing intense pain and stiffness in the fingers;
• A pilot begins to lose vision due to a progressive eye disease like macular degeneration, making it unsafe to fly airplanes;
• A high school teacher develops severe anxiety and panic disorder, making it impossible to manage a classroom or interact with students effectively;
• A long-haul truck driver is diagnosed with severe sleep apnea, leading to extreme fatigue and an inability to stay awake while driving;
• An accountant suffers from severe depression, leading to cognitive impairments and an inability to focus on detailed financial work;
• A legal assistant who develops severe depression and is no longer able to meet deadlines.

Remember—you, as the disability claimant, must prove that you meet this definition, which can be extremely challenging when faced with an insurance company that wants to pay as little as possible. A long-term disability lawyer can help you gather sufficient and thorough evidence, thus making it as difficult as possible for them to deny the severity of your disability. 

Then, generally at the two-year mark, most policies transition to a new definition, that of “any occupation.” Under this definition, you must remain unable to perform the core duties and tasks of any job for which you would be suited based on your experience, training, education, etc. 

What are some examples of “Total Disability” under the “Any Occupation” definition?

• A factory worker with a back injury may no longer meet this definition if they are physically capable of performing accommodated tasks such as an office or sales job in the same industry. However, if they can prove their injury also precludes them from working sedentary jobs, they’ll remain eligible for long-term disability benefits under this new definition;
• A person diagnosed with advanced multiple sclerosis experiences severe mobility issues, extreme fatigue, and muscle weakness, making it impossible to perform even sedentary jobs;
• An uneducated, hard-working janitor who suffers from osteoarthritis and is no longer able to ambulate properly;
• A teacher – who has only been educated as a teacher – with severe bipolar disorder, characterized by extreme mood swings, mania, and deep depression, making it impossible to maintain consistent work in a classroom setting;
• A contractor with severe cardiovascular disease who experiences extreme shortness of breath, chest pain, and fatigue, unable to perform even light or sedentary work without risk to their health;
• A restaurant server who experiences the onset of scoliosis-related symptoms later in life, making walking difficult;
• A dental hygienist with chronic neck pain;

Unfortunately, many claimants are unfairly terminated at the two-year mark. Insurance companies will insist the individual is suitable for “some type of job” and stop paying benefits. This is where the help of an experienced Hamilton disability lawyer once again becomes invaluable. They can help you prevent wrongful termination or help you get your benefits reinstated if they’ve already ended. 

2. Lack of Medical Evidence 

One should never underestimate the importance of medical evidence in a long-term disability insurance claim. Without solid, undeniable medical documentation, an insurance company can easily claim that you’re not too injured or disabled to work and, therefore, aren’t eligible for benefits. Unfortunately, many individuals don’t know exactly what evidence is best and don’t have access to the right experts and professionals. 

Remember—your disability claims adjuster is not an investigator. He or she will most likely only request your GP’s medical records. It is up to you to assemble years of clinical documentation to prove your case. When claimants retain our long-term disability lawyers, we request medical records as far back as they go to prove their disability. 

These records can include such things as: 

• Clinical notes from your GP;
• Clinical notes from all specialists;
• Clinical notes from all hospitals;
• Clinical notes from all imaging clinics;
• Clinical notes from all walk-in clinics;
• Clinical notes and records from all social workers;
• Clinical notes and records from all psycho-therapists;
• Clinical notes and records from all psychologists and psychiatrists;
• Clinical notes and records from all physiotherapists;
• Clinical notes and records from all chiropractors;
• Clinical notes and records from all acupuncture clinics;
• Clinical notes and records from all PSW’s
• Clinical notes and records from all Occupational Therapists;
• Clinical notes and records from all vocational therapists;
• Employment files;
• CRA records;
• Union records, and 
• Group benefit records;

While the various documents and reports gathered will depend on your specific case, these are some of the most common pieces of evidence a long-term disability lawyer will help you collect. Doing this yourself while trying to rest, heal, and recover is exceptionally challenging and stressful, thus increasing the likelihood of missed steps and, ultimately, a denial. Even more challenging is the high cost to obtain documentation on your own, which can easily run into the $1000s. 

3. Paperwork Errors

Unfortunately, an error in documentation can lead to a claim denial, even if a claimant is entirely eligible based on their injuries or disabilities. A long-term disability application requires plenty of paperwork at various stages – it’s easy to make a mistake or leave out important details. 

An experienced Hamilton long-term disability lawyer knows precisely what paperwork is required, when, and how to complete it best. They can completely alleviate the stress of paperwork errors in your long-term disability claim. 

4. Missed Deadlines

Another unfortunate but common pitfall is missed deadlines. Like errors, this can result in a denial regardless of the severity of an individual’s disability. Unless you can prove extenuating circumstances, exceptions are rarely made once a deadline has passed. 

Entrusting an experienced long-term disability lawyer with your case will ensure you meet the application deadlines. 

5. Record Discrepancies 

Long-term disability claims may be denied if there are too many discrepancies between your claims and statements, as well as the medical records and/or claims and statements by witnesses, employers, etc. 

This is why it’s essential to remain consistent and thorough, report all your symptoms, receive all recommended treatment, etc. Working with an experienced Hamiton long-term disability lawyer can help you stay consistent and ensure you’re backing up all your claims and statements with adequate evidence. 

6. Social Media Investigation

Social media can significantly impact a disability case, often to the claimant’s detriment. Posts, images, or videos shared online can be easily misinterpreted by insurance companies and used as evidence against a disability claim.

For example, a photo of a claimant attending a family gathering might be misconstrued as proof of physical capability despite the individual experiencing significant pain and fatigue shortly after the event.

Similarly, a video of someone with a back injury briefly lifting a light object might be taken out of context and used to argue that they are not as disabled as their medical records indicate. Such misinterpretations can lead to questions about the claimant’s credibility and compliance with medical treatment plans, potentially jeopardizing their eligibility for benefits. Claimants must be mindful of their online presence and understand how even innocent posts can be used against them in a disability case.

7. Non-Compliance With Treatment 

Insurance companies may deny claims if the claimant does not participate in recommended therapies, doesn’t take prescribed medication, or refuses treatments and rehabilitation plans. This can make it look like you’re not interested in healing and recovering to the best of your ability or that your condition is not as severe as you claim. If you’re ever unsure about a treatment, medication, or other medical recommendation, you can always speak to your doctor or other involved professionals to get more insight or to try something else. 

If your Long-Term Disability Benefits Claim has been Denied, we can Help. Based in Hamilton, our Long-Term Disability Lawyers Serve Claimants Nationwide.

If your long-term disability benefits claim has been denied, we can help. Our Hamilton long-term disability lawyers have been representing claimants for over 40 years, and we understand the challenges of navigating this process while undergoing treatments and rehabilitation.

We are here to remove the legal complexities from your shoulders, allowing you to focus on your healing and recovery. Our consultations are always free of charge. During your consultation, we will thoroughly review your case, address any questions or concerns, and provide our best legal advice.

Please don’t hesitate to contact us. It’s never too early to seek legal advice and hire a long-term disability lawyer. Your well-being is our priority, and we are dedicated to helping you secure the benefits you deserve.

Call us today at 1-844-4-DISABILITY or send us an email through our website to set up your free consultation today. All calls are completely confidential and we will get back to you promptly. 

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