If you are not able to work due to an injury or an illness, it is very important for you to be aware of the main reasons why an insurance company may deny your long-term disability claim. With knowledge of the five most common reasons why claims are denied, you may be able to avoid making mistakes that could cost you your long-term disability benefits.
1. Clerical or Procedural Errors
If anyone involved with your disability claim – the insured person, doctor, or lawyer – does not send all of the required documentation to the insurance company in a timely manner, you may be denied. Furthermore, there are statutory limitation periods that define the allowable amount of time between completing an insurance claim and filing for a lawsuit. After this period, you may be prevented from claiming disability benefits.
2. Having Pre-existing Medical Conditions
If you have a pre-existing medical condition before becoming insured, most private disability insurance policies (it must be noted that these are different than employee group policies) will require an exclusion of benefits related to the particular pre-existing condition for defined period of time.
3. Committing Fraud or Misrepresentation
Do not misrepresent yourself in any of the documents required for insurance application (health questionnaire, disability claims form, etc.). Any misrepresentation can result in your insurance policy being declared void. The best approach is to be completely honest, and include all medical and occupational details even if you do not think they are relevant. Let the insurance company decide what is and is not relevant.
4. Not Meeting Eligibility Requirements
Some long-term disability claims are denied because of a failure to meet previously determined contractual eligibility requirements. For example, if you are part of an employee group long-term disability policy, there may be non-medical requirements, such as being employed for a defined period or working a stipulated minimum of hours, before you are considered eligible for the disability policy.
5. Policy Exclusions
Insurance companies specify clauses within their policies that allow them to avoid paying disability benefits in certain situations. Common clauses involve the injured person having engaged in specific acts that led to the disability, such as committing a crime or illegal act, intentionally self-inflicting the injury, or being injured as a result of drug or alcohol use.
It is important to know the reasons that an insurance company may turn down your disability claim, so that you can do your best to avoid having your claim denied.
>> Roger R. Foisy has extensive experience as an Ontario Personal Injury Lawyer. Do not hesitate contact us today for immediate support and a free consultation.