Articles for Non-Lawyers

Photo: Long Term Disability Insurance is Denied

Top 6 Reasons Insurance Companies Deny Long Term Disability Claims by Patricia Santucci

1. Failure to meet the definition of “disabled”

Long Term Disability is based on a contract. The definition of disability is set out in the contract (your policy). There are two basic definitions of disability in most policies. The first one is applied usually for two years and requires you to be medically unable to work at your own occupation. Usually after two years the definition of disabled changes and requires you to be medically unable to perform the essential duties of any occupation for which you are reasonably qualified by training, education or experience. Failure to meet this definition is a very common reason that insurance companies deny LTD benefits. (See also: LTD FAQ).

2. Lack of “objective” evidence

Insurance companies will often deny benefits on the basis that the claimant failed to provide sufficient objective evidence of disability. Objective evidence can include medical reports from treating physicians, laboratory reports, x-ray reports, etc. Subjective evidence (your own description of your disability) is not enough to justify your claim.

3. Social media posts

Insurance companies gather evidence to justify denial of claims on social media and networking sites like Facebook. A single image of you being active and happy is enough to suggest that you are not disabled or in pain. This is powerful evidence in the hands of an insurer and can be used to deny your claim, especially when the evidence portrayed contradicts the evidence that you have provided.

4. Report from an “independent” medical examiner

The insurance company will make you go to an independent medical examination (IME). They will use the report from this examination as evidence to justify terminating your benefits.

5. Missed limitation period

The limitation period is the time that you have to start your legal action in order to receive disability benefits. If your action is not commenced within the limitation period, you will completely lose your right to claim disability benefits. Insurance companies use this as the basis of denials.

6. Non-compliance with doctor’s advice

Insurance companies will deny your benefits if you do not follow the advice of your doctors and seek the recommended treatment. (See also: LTD FAQ).

About the Author Patricia Santucci

Patricia Santucci is a personal injury lawyer born and raised in Hamilton, Ontario. She holds several degrees having attended King’s College at the University of Western Ontario, McMaster University, earned a Master of Arts degree at the University of Windsor and an Ontario Teaching Degree from Teacher’s College as well as her Ontario Teaching Certificate. After graduating from the University of Alberta law school she was called to the bar in 2000. You can find Patricia on and LinkedIn or directly through this website