Reasons Why Your LTD Claim May be Denied and What You Can do

décembre 1, 2020  |  Non classifié(e)

Reasons why your LTD claim may be denied and what you can do?

If you’ve been rendered disabled or unable to work due to a medical condition, physical injury, or any other reason, you may be entitled to long term disability benefits. This income is critical during this time as it enables you to care for  yourself and your family while out of work. However, there are cases where LTD claims are denied due to reasons such as missing medical records. We’ll go over some of the reasons why your Nova Scotia LTD claim could be denied and advise you on how to go about it.

  1. You don’t meet the definition of disabled as stated in your policy

Most policies will define disability as either ‘own occupation’ or ‘any occupation’. To qualify for disability benefits under ‘own occupation’ you must only be unable to perform the duties of your specific occupation. On the other hand, policies which use ‘any occupation’ may pay LTD benefits to victims if they are considered unable to fulfil the responsibilities of any occupation. Therefore, your claim will be denied if you have a disability that prevents you from performing the requirements of your specific occupation if you are still able to perform other work.

  1. Hard records that document your disability symptoms

There are certain LTD claims that are denied simply because the person lacks hard records such as MRI and blood tests that prove their disability. For instance, symptoms such as depression and fatigue may be considered subjective and could lead to your claim being denied if there are no other medical records to support your claim.

  1. Presence of a pre-existing condition

Most insurance policies have a waiting period of about 12 months before they can provide coverage for pre-existing conditions. These exclusions may result in your LTD benefits being denied. For instance, if you submit a claim for a pre-existing condition that you did not earlier disclose, your claim may be denied.

  1. Missing medical records

Sufficient medical records to support your LTD claim are a must-have. If you lack adequate medical records on your file to prove your disability, your claim may be denied.

  1. Lack of adequate proof to document the disability

To further prove your disability, insurance companies are looking for evidence such as ongoing medication and regular treatment. Disability often requires the regular care of a physician. You must document this to increase the chances of your claim being approved.

  1. There’s evidence that you perform activities that your disability should prevent you from performing

Insurance companies could  hire an independent investigator to monitor your daily activities. During this time, the insurer can take video surveillance of your day to day activities to show you can still perform the activities that you claim you cannot. This could lead to your claim being denied.

If your LTD claim was denied, you need an experienced lawyer by your side to help you get the benefits you were promised. Talk to us wherever you are in Nova Scotia.

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