Ask an Insurance Denial Lawyer: April 20, 2017



  • @chloe: If you had an own occupation clause built into your policy, you likely would have purchased a rider that would remove the change of definition (in other words, the rider would prevent the definition from changing to any occupation). You should also contact the insurance broker who sold you the policy to assist with your request.
    @chloe said:

    @martinw Thank you. I seem to recall having an owner occupation clause built into my personal policy, but when I spoke with the adjuster for my LTD policy, she denied that I had this clause. She also mentioned a redefinition after 24 months, Can I ask you what does that mean?



  • Thanks, @chloe and @martinw.

    @martinw, can you talk about common reasons why disability claims get denied?



  • @martinw Thank you. I seem to recall having an owner occupation clause built into my personal policy, but when I spoke with the adjuster for my LTD policy, she denied that I had this clause. She also mentioned a redefinition after 24 months, Can I ask you what does that mean?



  • @chloe Thank you for your question. It is a common question when a person is denied. Under the Insurance Act, the insurer is required to provide you with a copy of the policy. Coupled with a freedom of information request, you may address your request to the insurer's ombudsman. The best course may be to approach the broker who sold you the policy for assistance.



  • @martinw Good Morning,
    My question relates to access to my full policy. I purchased an LTD plan in 1994 and I do not have the original copy. I have requested a copy from my carrier last year and I have still not secured the full policy . Please advise what actions I can take to secure the original copy.



  • @Forum_Moderator To make a claim for disability benefits, you first need to have coverage under either a group policy through your employment or through an individually purchased disability policy. These policies are contracts, and govern the rights and obligations of the parties. The term “total disability” or “totally disabled” is defined within the policy (not all policies have the same definition for total disability, and some have more onerous definitions than others). To be successful with a claim for disability benefits, the onus lies on the insured to provide sufficient evidence that the insured meets the definition of total disability.



  • Thanks for that info, @martinw . Here's another question we often hear:

    How do you know whether you can make a claim for disability benefits?



  • @Forum_Moderator It is difficult to say how common it is for disability claims as a whole to be denied. What appears to be clear though is that disability claims resulting from certain conditions are more likely to be denied than others. In particular, disability claims arising from what is described as “subjective” or “invisible” conditions have a higher instance of denial. These conditions include fibromyalgia, chronic fatigue syndrome, and in particular, claims arising from complex and chronic pain where the etiology of the pain condition cannot be confirmed by means of “objective” means such as imaging (MRI’s, CT scans, x-rays etc. Another group of claims that are routinely denied (and strictly scrutinized), would be those resulting from mental health illnesses. These claims are quite often linked to a chronic pain condition.



  • Let's begin with a general question: How common is it for disability claims to get denied?



  • @martinw We're so glad to have you with us today!



  • Good morning everyone. Welcome to the event. I hope the answers posed will be helpful to those living with pain and dealing with denied disability claims.



  • Hello all! We're almost ready to begin today's Ask the Expert with Martin, a disability lawyer. We'll begin at 9:30 AM on the dot. Thank you to all who posted their questions in advance on Facebook, and welcome to those who are joining us live today.

    Just a reminder that Martin will do his best to answer questions in a general way, and won't be providing individualized advice.


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