Why long-term disability claims are denied at Midland
What insurance companies don’t tell you and how you can be an informed insured
Disability insurance companies are notorious for denying coverage for reasons that seem unfair. If you have an illness or injury that prevents you from earning a living, you should be able to count on disability insurance benefits.
âInsurance companies don’t tell you their job is to find every way not to pay claims,â said Samantha Share, deputy managing director of Share Lawyers. Unfortunately, applicants often do not contest a disability insurance denial because they are intimidated and believe the little guy has no chance of winning against a disability insurance giant.
However, armed with the right information and the right preparation, you can successfully challenge disability insurance denials. Here are the top reasons why disability insurance claims are denied at Midland, and why you should dispute them.
Inadequate medical evidence
The insurance company claims that the diagnostic documentation or the doctor’s assessment of your inability to work is not convincing enough. This is a common blocking tactic. Share said: “Insurance companies can use tactics such as referral to an independent medical assessment or rehabilitation services to gather more information in order to delay payment of benefits.”
If this is the reason for you, consider calling a disability lawyer or use this free online tool to find out how an experienced lawyer can help you because contesting a claim balances the playing field.
Pre-existing exclusion clause
Under Ontario law, an insurance company is protected against the obligation to provide benefits to people who would never have been insured had the condition been disclosed beforehand. However, these clauses are often subject to interpretation and an experienced disability lawyer may be able to determine that the insurer’s chronological analysis is not valid or that the claim is based on a new medical condition that would not be covered by the pre-existing exclusion clause. .
Determination of “total disability”
If your illness or injury prevents you from performing the main tasks of your “own occupation”, you may be entitled to disability benefits. After 12 to 24 months, a medical consultant will determine if you can switch to âall professionsâ coverage. Often times, insurance companies will say that even if they accept that you cannot do your own job, you should be able to do something, which leads you to believe that you must have some illness or disease. catastrophic injury. But this is the furthest thing from the truth. To determine if you can overcome this termination of benefits, you should consult an experienced disability lawyer.
You are under surveillance
Often, insurance companies use private investigators to track people in their daily lives. The thought of being followed by a stranger looking for a moment of âembarrassmentâ can be nerve-racking. Unless you are lying about your injury or illness, there is nothing to worry about.
Their medical expert contradicts your doctor
Their doctor does not think you are disabled. Who will believe a judge, an insurance consultant who has performed a brief assessment of your condition, or your own doctor who has treated you for years? Share said: “They often refer to an internal medical consultant on which to base their decision not to pay for benefits.”
What’s your next step?
Applicants who have been denied disability benefits should use one of the free online tools available to find out if they have a valid disability case and not wait to call a disability lawyer. The longer they wait, the more they will have no income. Samantha Share said: âA disability lawyer can immediately initiate the appeal or prosecution process. They can also make suggestions as to other forms of income that may be available to the applicant during the waiting period.