Long Term Disability (LTD) benefits are essential when you are unable to work due to illness or injury. Unfortunately, many people in Ontario find themselves dealing with the frustration and financial stress of a denied claim. As a personal injury and disability insurance lawyer, Tony Lafazanis has seen how overwhelming these situations can be.

Let’s simplify the most common reasons for denial and explore what you can do to challenge the decision and receive the benefits you are entitled to.

Meeting the Disability Definition: A Common Stumbling Block

Insurers’ Strict Definition of “Totally Disabled”
One of the most common reasons for a denial is the insurance company’s determination that your condition does not meet their stringent definition of “totally disabled.”

Your Action Plan
Collaborate with your healthcare provider to demonstrate how your condition significantly impacts your ability to perform work-related tasks. Detailed medical reports and expert opinions are crucial in proving your case. Make sure every aspect of your condition’s impact on your work life is thoroughly documented.

The Importance of Medical Evidence: More Than Just Paperwork

Why Insufficient Medical Evidence Can Sink Your Claim
Insurance companies require extensive and detailed medical documentation to validate your inability to work. If they deem your evidence insufficient, they will likely deny your claim.

What You Can Do
Start documenting your medical condition as early as possible. Keep records of every medical visit, treatment, and doctor’s note. At our law firm, we can assist by coordinating with your healthcare providers to ensure that all necessary documentation is complete and compelling.

Navigating Policy Technicalities: Don’t Get Tripped Up

The Complex World of Policy Terms
LTD policies can be complicated, and insurers may attempt to rely on technicalities to justify a denial.

Your Best Defense
Always read your policy’s fine print carefully even before buying the coverage. If you are now making a claim and any terms are unclear, seek advice from a legal expert. Our team can review your policy, explain confusing terms, and help you understand your rights and obligations to avoid potential pitfalls.

Compliance with Treatment: The Key to Success

How Non-Compliance Can Jeopardize Your Claim
Insurance companies may deny your claim if they suspect you have not followed recommended treatment plan. This could include missed doctor appointments, not taking prescribed medications, or skipping therapy sessions.

Stay on Track
Follow your treatment plan diligently. If you have concerns about any aspect of your treatment, discuss them with your doctor rather than discontinuing treatment on your own. Compliance is crucial for both your recovery and the success of your claim.

Pre-existing Conditions

The Hidden Trap
Insurance companies may deny your claim if they believe your disability stems from a pre-existing condition. Essentially, they argue that your inability to work isn’t due to a new injury or illness but rather a pre-existing health issue.  This likely only applies if you have just become insured under the policy.

How to Overcome This
Collect comprehensive medical evidence to clearly distinguish your current condition from any pre-existing health problems. Work with your doctor to provide detailed documentation that explains how your current disability is unrelated to previous conditions.

How Tony Lafazanis LTD Lawyer Can Help You Fight Back!

If your LTD claim has been denied, do not give up. With over 40 years of experience in handling long term disability cases, Tony Lafazanis can guide you through the appeals process and fight for the benefits you need. Contact us today for a FREE consultation to discuss your case. We are committed to helping you secure the LTD benefits you deserve.