Long term disability insurance companies often deny LTD claims on the basis that the plaintiff or claimant lacks objective evidence of an injury or disease. This can be used as a technique to dissuade plaintiffs from filing a lawsuit. The long term disability insurer often defends claims in courts on the same premise.
Things become more interesting when you ask an LTD insurer representative, under oath, to clearly define the specific objective evidence necessary to approve a long-term disability claim. In most cases, the insurance company’s representatives avoid the question and probably concede that a plaintiff can meet the set definition of ‘disabled’ based on various subjective symptoms. The objective evidence requirement is one of the biggest myths propagated by long-term disability insurance providers.
Injury versus function
Even in a situation where a plaintiff can prove an objective injury or illness like lesions on the brain, herniated disc, or fracture, his or her claim can still possibly be denied. LTD insurance companies often argue that while there is objective evidence of a disease or injury, there is no sufficient objective evidence that demonstrates a loss of function. That means the reported symptoms of an objective illness or injury are still too subjective. This can be the LTD insurance company’s plan B.
Generally, there are many diseases that cannot be definitively proven by a scan or a test. Long term disability insurers deny mental illness-related claims on the basis that the symptoms and diagnosis are entirely subjective in nature. Also, there is a bias against environmental-related illnesses such as fibromyalgia, Lyme disease, and gastrointestinal disorders such as irritable bowel syndrome. The reality is that patients battling these diseases are entitled to get long term disability benefits if they cannot function in their line of duty.
An experienced LTD lawyer can help
The good news is that there are several cases in Canada where juries and judges have wholeheartedly rejected this concept fostered by long term disability insurance companies. This doesn’t mean the insurer will make things easy for you. Actually, most insurance companies retain a medical specialist, a medical consultant, or an occupational therapist to conduct an in-depth review of a claimant’s application.
In case the matter is already in litigation, the LTD insurer may ask you to undergo a medical examination. If the occupational therapist or medical consultant supports the insurance company’s argument, it is up to you (the plaintiff) to get your own expert to challenge the insurance company’s arguments. This is where a professional long-term disability lawyer comes in. He or she can provide the resources you need to acquire expert evidence and successfully challenged the insurer’s arguments.
One common question among many claimants revolves around who will pay for the expert evidence needed to win in a long term disability claim. The straight forward answer is usually the long term disability insurance company, particularly when they realize that you are ready to challenge the claim denial in court. Sometimes, the threat of retaining expert witnesses might be enough to force the long-term disability insurance company to approve LTD benefits. Keep in mind that pursuing a long-term disability claim successfully or litigating such matters is a highly complex legal field.
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