LTD Denial in Toronto: What It Means and How to Fight Back

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Facing a Long-Term Disability (LTD)

Facing a long-term disability (LTD) is stressful and can be difficult to navigate. Getting treatment for your disability is further complicated when you must worry about financial support. LTD benefits are designed to provide for lost income to those unable to work due to a serious injury or illness. However, insurance companies often deny these claims, leaving many people in Toronto and across Ontario without the critical support they need.

At Bergel Magence, a trusted Toronto-based personal injury law firm, we understand how devastating an LTD denial can be. With over 50 years of experience helping Torontonians, we’ve successfully challenged numerous denied LTD claims, ensuring our clients get the benefits they deserve.

To help you understand LTD denials and how you can fight back, let’s explore common reasons LTD claims are denied, what steps to take when your claim is rejected, and how a personal injury law firm like Bergel Magence can assist in appealing a denial.

What is Long-Term Disability Insurance?

LTD insurance is a safety net for individuals who become unable to work for an extended period due to a serious injury or illness. Whether you live in downtown Toronto, Ottawa, Hamilton, or Brampton, if you have LTD coverage through your employer or have purchased it privately, these benefits are designed to cover a portion of your income while you are unable to work.

Most LTD policies provide between 60% and 85% of your pre-disability income. Depending on the policy, these benefits can last from two years to the retirement age of 65. However, qualifying for LTD benefits in Toronto can be tricky, as insurance companies frequently deny claims for a variety of reasons. Knowing why these claims get denied is crucial if you want to fight back and get the financial support you need.

What are Common Reasons for LTD Denial in Toronto?

Insurance companies, including those that serve Toronto residents, often deny LTD claims in an attempt to minimize their long-term financial obligations. Here are some of the common reasons for LTD denials in the Greater Toronto Area (GTA):

1. Insufficient Medical Evidence:

One of the top reasons insurance companies deny LTD claims is the lack of medical evidence supporting your disability. If your medical records aren’t thorough enough to demonstrate your inability to work, your claim could be rejected. Ontario healthcare providers can provide detailed medical documentation that may support your case, but you need to ensure these records are submitted with your claim.

2. Pre-Existing Conditions:

Many LTD policies contain clauses that exclude coverage for pre-existing conditions. If your insurance company believes your disability stems from a medical condition you had before you were covered, they might deny your claim. This is especially common in Toronto, where many residents have comprehensive medical histories due to access to world-class healthcare services.

3. Failure to Meet the Definition of Disability:

Every LTD policy has a specific definition of disability, which may vary from “own occupation” to “any occupation.” Toronto claimants often find that their insurer rejects their claim because they don’t meet these criteria. Some policies cover disabilities that prevent you from working in your specific job, while others require that you cannot work in any job at all.

4. Surveillance and Social Media Monitoring:

Insurance companies will often conduct surveillance or monitor social media to find evidence contradicting your disability claim. For example, if you’re living in Toronto and post pictures of yourself at a Raptors game, standing and cheering for Scottie Barnes, insurers may use this against you, even if the activity didn’t worsen your condition. Or if it’s summer and you are posting pictures of you kayaking at your Muskoka cottage, they may say that your injury claim isn’t valid as you were able to be active.

5. Missed Deadlines:

LTD claims in Toronto must be submitted within specific timeframes. If you fail to file your claim or provide requested documentation within the deadlines, your claim may be denied. This is why it’s critical to consult with a Toronto personal injury lawyer who can help you stay on top of these deadlines.

6. Non-Compliance with Treatment:

If your insurer believes you’re not complying with your medical treatment or rehabilitation, they may deny your claim. Toronto is home to many top-tier medical specialists, and you must follow their prescribed treatments carefully to ensure that the insurance company cannot use this as a reason for denial.

What To Do if Your LTD Claim is Denied in Toronto?

If you’ve received a denial letter for your LTD claim, don’t panic. You have options, but it’s essential that you act immediately.

Here’s what you should do if your LTD claim has been denied:

1. Review the Denial Letter:

Make sure you thoroughly review the denial letter from your insurer. The letter will explain why your claim was denied. Understanding the insurer’s reasoning will help guide your next steps.

2. Gather Additional Evidence:

If your LTD claim was denied due to a lack of medical evidence, you can potentially overcome this by gathering additional documentation. This could be medical reports from Toronto specialists, specific records from local hospitals like Sunnybrook or Mount Sinai, and detailed statements from your primary care physician. Strengthening your medical evidence helps back your injury claim and is often the best way to challenge a denial.

3. Consult a Toronto-Based Personal Injury Lawyer:

Navigating the appeals process on your own can be daunting and difficult, especially when you’re dealing with a serious illness or injury. Consulting with a personal injury lawyer who specializes in LTD denials in Toronto can significantly improve your chances of success. At Bergel Magence, we’ve helped countless Ontarians successfully appeal LTD denials. If you have been denied, we can most likely help.

4. File an Appeal:

Your insurance company likely has an internal appeals process. The timeline for submitting an appeal is typically between 60 and 180 days, so it’s important that you act quickly. Your appeal should address the reasons for denial and include any new evidence that supports your claim.

5. Request an Independent Medical Examination (IME):

If the insurer disputes the severity of your condition, you can request an IME from a physician not affiliated with the insurance company. Many qualified specialists in Toronto provide unbiased assessments, which can help prove the extent of your disability.

6. Consider Legal Action:

If your appeal is unsuccessful or the insurance company continues to delay or deny your claim, you may need to consider filing a lawsuit to recover the benefits you may be entitled to. A local Toronto personal injury lawyer can represent you in court and advocate for your rights.

How Can a Toronto Lawyer Help with LTD Denial?

Challenging an LTD denial is often an uphill battle. Hiring a Toronto personal injury lawyer with experience in LTD denials can make a big difference. Here’s how we can help:

Understanding the Policy: LTD policies are often complex and nuanced, with various terms and exclusions. A local personal injury lawyer will help you understand your policy and identify where the insurer may be wrongfully denying your claim.

Building Your Case: Your personal injury lawyer will work with Toronto-based medical experts to gather the necessary evidence and documentation to support your appeal.

Negotiating with the Insurance Company: We will negotiate with the insurer on your behalf to ensure your case is presented effectively and fairly.

Representing You in Court: If the case goes to court, your lawyer will represent you in Toronto’s courts and fight for your right to LTD benefits.

How to Prevent an LTD Denial in Toronto?

While there’s no su

refire way to prevent an LTD denial, there are steps you can take to improve your chances of having your claim approved:

1. File Your Claim Promptly:

As soon as you realize you cannot return to work due to a disability, file your LTD claim. The sooner you start the process, the better.

2. Follow Your Doctor’s Orders:

Be sure to follow all treatment plans and attend all medical appointments with Toronto healthcare providers. This will demonstrate to the insurer that you are doing everything you can to recover.

3. Keep Detailed Records:

Keep thorough documentation of your medical visits, treatments, and any communications with your insurance company.

4. Be Mindful of Social Media:

Avoid posting anything on social media that could be interpreted as contradictory to your LTD claim.

Facing an LTD denial can be incredibly stressful, but it’s important to remember that you have the right to challenge the decision. Bergel Magence has decades of experience helping clients in Toronto successfully appeal LTD denials. If your LTD claim has been denied, contact us at 416-665-2000 or visit our website at bergellaw.com for a free consultation. We’re here to help you fight for the benefits you deserve and navigate the complexities of the legal system in Toronto.

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