Denied disability benefits? Here’s what to do if you still can’t work
By taking the right steps, you can challenge the insurance company’s decision and fight for the benefits you deserve
Article content
Receiving a denial letter for your long-term disability claim can be devastating. You’ve paid your premiums and relied on this support for financial security, but now you’re left wondering what to do next.
If your claim has been denied, don’t lose hope. By taking the right steps, you can challenge the insurance company’s decision and fight for the benefits you deserve.
Recommended Videos
tap here to see other videos from our team.
Denied disability benefits? Here’s what to do if you still can’t work Back to video
tap here to see other videos from our team.
And you are not alone in coping with a disability. In 2022, a Statistics Canada report showed the disability rate for persons aged 15 years and older in Canada was 27 per cent. This represents nearly eight million people who were identified as having one or more disabilities, an increase of 1.7 million people over 2017, when the disability rate was 22 per cent.
Not surprisingly, statistics show that disability rates increased with age: one in five (20 per cent) youth aged 15 to 24 years had one or more disabilities in 2022, compared to one in four (24 per cent) adults aged 25 to 64 years and two in five (40 per cent) seniors aged 65 years and over.
If your workplace benefits policy won’t cover you, there are several government benefit programs you can apply to for help, such as Employment Insurance, the Ontario Disability Support Program or Canada Pension Plan’s disability benefits program.
However, if you decide to fight your insurer’s decision, the first critical step is to carefully review the denial letter from your insurance company. This document will typically outline the reasons for the denial, such as lack of sufficient medical evidence, a disagreement about the severity of your condition, or claims that you do not meet the definition of “disabled” under the policy.
Understanding why your claim was denied is essential to building a strong case for overturning this decision.
Your physician’s role is particularly important at this stage. Their medical findings should clearly explain the severity of your condition, your limitations
and why you’re unable to work.
Many insurance companies encourage claimants to pursue an internal appeal as the next step. While this option may seem appealing because of its simplicity, it’s often a strategy designed to benefit the insurer rather than you. Internal appeals are typically handled by the same people who denied your claim in the first place, which means the chances of a reversal are slim.
It can be more effective to take legal action with the help of a disability lawyer. An experienced lawyer can file a lawsuit against an insurance company on your behalf, handling all the paperwork, court processes and deadlines, so you can focus on your health.
You need to be prepared to act quickly. When a claim is denied, there are strict deadlines for taking legal action. If you wait too long, you may lose your ability to sue the insurance company and recover the benefits to which you’re entitled. Contacting a lawyer promptly will ensure your case is handled within the required timeline and avoid costly delays.
In most cases, settlements with your insurance company can be achieved by reviewing medical evidence, considering the possibility of recovery, and calculating future litigation risk. A settlement could involve either a reinstatement of your benefits or a lump sum payout, and a waiver of premiums if you paid premiums to keep a policy in place despite the denial of benefits.
Being denied long-term disability benefits is not the end of the road. With the right steps, you can push back against the insurance company and secure the benefits you need.
Nainesh Kotak is the founder of Kotak Personal Injury Law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. He was Past Chair of the Long-Term Disability Section of the Ontario Trial Lawyers’ Association.
