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Common Reasons for LTD Denials

Wednesday, August 14, 2024

Primary Blog/Long Term Disability/Common Reasons for LTD Denials

Denial of Long-Term Disability (LTD) claims can be frustrating for individuals who are unable to work due to a disabling condition. While each case is unique and decisions can vary, there are some common reasons why LTD claims may be denied. It’s important to note that this information is general in nature, and specific policies and regulations may vary. Consult with a qualified disability lawyer or your insurance provider for advice tailored to your situation.

Here are some common reasons for LTD denial:

1. Insufficient Medical Evidence

Incomplete or inconsistent medical documentation that fails to demonstrate the severity and impact of the disabling condition on work capacity.

Lack of clear and convincing medical evidence supporting the disability claim.

2. Pre-existing Conditions

Policies may exclude coverage for pre-existing conditions, especially if they are not disclosed during the application process.

3. Failure to Meet the Definition of Disability

The inability to prove that the disability prevents the claimant from performing the duties of their own or any occupation, as defined by the policy.

The disabling condition may not meet the specific criteria outlined in the insurance policy’s definition of disability.

4. Misrepresentation or Fraud

Failing to disclose relevant information about the medical history or employment status.

Providing false or misleading information during the application process can lead to denial.

5. Failure to Follow Treatment Plans

If the claimant does not follow prescribed medical treatments or fails to attend required medical appointments, the claim may be denied.

6. Missing Deadlines

Failure to adhere to deadlines for filing claims, appeals, or providing requested information can result in denial.

7. Not Enough Work Credits

Some disability insurance policies, especially Social Security Disability Insurance (SSDI), require a certain number of work credits. If the claimant hasn’t worked enough, they may be ineligible.

8. Occupational Exclusions

Certain policies may exclude coverage for disabilities resulting from specific occupations or activities.

9. Failure to Cooperate

Refusing to cooperate with the insurance company’s requests for information or examinations may lead to denial.

10. Change in Definition of Disability

Some policies may have a change in the definition of disability after a certain period. For example, transitioning from the inability to perform one’s own occupation to any gainful occupation.

11. Mental Health Limitations

Some policies may have limitations on mental health conditions, such as restricting coverage to a specific time frame.

Conclusion

If your LTD claim is denied, it’s crucial to carefully review the denial letter, understand the specific reasons for denial, and consider seeking legal advice to appeal the decision if you believe it is unjust. It is not uncommon for these grounds to be stated as the reason for the denial when the claim should actually have been approved. Consulting with an experienced lawyer specializing in disability claims can provide valuable guidance through the appeals process.

Contact Catherine for a free legal consultation. We provide legal services for LTD denials throughout Canada.

This article was written by Personal Injury Lawyer, Catherine Shearer. For additional information, please do not hesitate to contact her at catherine.shearer@mckenzielake.com or visit her Instagram page @guelphinjurylawyer.

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