Ryan Findlay | September 18, 2023 | Long-Term Disability
Has Canada Life Denied Your Long-Term Disability Benefits?
LTD Claim Denied by Canada Life?
If Canada Life has rejected your long-term disability payments, you’re undoubtedly disappointed and overwhelmed. After all, you’ve been paying into your policy for years, and now, when you need it the most, the insurance company says you’re ineligible.
Don’t lose hope just yet! Denial of long-term disability compensation is sometimes only the first step in a protracted appeals process. Canada Life, like many other insurance companies, dislikes paying claims. They frequently mislead policyholders in the belief that they would just give up and leave.
You do not have to go through this alone! Our team of personal injury lawyers in Hamilton, we approach the legal process collaboratively. Our experts, case managers, and lawyers have the medical understanding required to put together a compelling petition on your behalf.
We will go through your denial letter to see whether you have a case. If we feel you do, we will devise a strategy for acquiring the requisite medical proof and witnesses to support your claim.
We realize how stressful this time may be, and we’ve dealt with insurance providers like Canada Life for years. We understand their strategies and how to counter them. You may be able to obtain the benefits you want and deserve with the assistance of a knowledgeable disability lawyer. If you have any questions concerning our costs or services, please call us at 905-522-9799 or visit one of our locations.
Long-term Disability Claim Denied by Canada Life
Insurance companies in Ontario deny the vast majority of eligible long-term disability (LTD) claims. According to industry statistics, about 60% of all long-term disability claims are denied each year.
Canada Life will normally send you a letter informing you that your long-term disability claim has been refused and encouraging you to appeal the insurance company’s decision. This is done in the hopes that the insurance company can handle matters directly with the applicant, avoiding a long legal battle.
It is critical to recognize and understand your rights before proceeding with the appeals system. Dealing with insurance companies without a lawyer is difficult and, in most situations, not recommended. A long-term disability lawyer will assist you in appealing the insurance company’s decision and, if required, taking your case to court.
What Happens If My Long-Term Disability Claim Is Denied?
When you initially apply for long-term disability benefits, the insurance company will ask you to supply detailed medical information. Your information will also be reviewed by the insurance company’s own doctors. The insurance company may even insist that you attend an independent medical examination (IME) with one of their doctors in specific situations.
The IME is necessary because it allows your insurance company to obtain a second opinion on your health and how it impacts your capacity to work. It is crucial to emphasize, however, that the IME is not binding on the insurance company. In other words, even if the IME doctor determines that you are incapacitated, your insurance company may still refuse your claim.
Common Causes for Denial of a Long-Term Disability Claim with Canada Life
There are several reasons why Canada Life may deny a person’s long-term disability claim. Among the most prevalent reasons are:
1) Policyholder Does Not Fit The Definition Of “Disability”: One of the most prevalent reasons for rejection is that the policyholder does not meet the definition of “disability” in their policy. Every long-term disability insurance defines disability differently, so it’s critical to read your policy thoroughly.
2) Pre-Existing Conditions: If the insurance company asserts that your ailment is pre-existing, this is another typical basis for refusal. This might be tough to verify, so keep all of your medical documents in order.
3) Not Being “Entirely” Or “Absolutely” Disabled: Most policies need you to be “totally” or “completely” disabled in order to qualify for long-term disability benefits. This implies you must be unable to perform any job, not just your own.
4) The Policy Has A “Limit”: Some long-term disability policies include a “cap” on how much you can get in payments. This implies that the amount of money you may get from the coverage is limited, regardless of how long you are handicapped.
5) You have not been out of work for a long enough amount of time: Most long-term disability insurance requires a waiting period before payments are paid. This might range from 3 to 6 months. Your claim will most likely be refused if you have not been out of work for the appropriate period of time.
6) Your Illness Or Injury Is Insufficiently Serious: In order to qualify for long-term disability payments, your illness or injury must be severe enough to keep you from working. If the insurance company does not feel your condition is significant enough, your claim may be denied.
7) You Worked In A Dangerous Occupation: Some long-term disability insurance does not cover injuries or illnesses that occur while working in a dangerous occupation. This implies that if you are injured while working in a hazardous occupation, your claim may be dismissed.
8) Filing a Claim Late: You may only have a certain amount of time to make a long-term disability claim. Your claim may be refused if you miss the deadline.
9) Failure to Communicate With Your Insurance: It is critical to maintain open lines of contact with your insurer. If you do not answer their information requirements, they may refuse your claim.
10) The Coverage Has Lapsed: Your claim may be refused if you have allowed your long-term disability policy to expire.
If you have been refused long-term disability payments by Canada Life, you should consult with an lawyer as soon as possible.
Appealing A Denied LTD Claim with Canada Life
There are various grounds for filing an appeal. For example, if your claim was refused because Canada Life claimed your illness was not covered by the policy, you can file an appeal arguing that it is. Another typical cause for long-term disability benefit refusal is that Canada Life believes your illness is not “serious enough.” An appeal might be made on the grounds that the insurance company’s definition of “severe” is excessively narrow.
Most individual or employee long-term disability policies require you to demonstrate complete disability throughout the qualifying period and the first 24 months or two years of long-term disability in order to qualify for payments.
The “Own Occupation” Clause
During the first 24 months (2 years) of long-term disability, most long-term disability policies include an “own occupation clause,” which means that if you are unable to perform the essential tasks of your particular occupation or job, you will be considered disabled and eligible for long-term disability benefits, even if you can do other types of work.
The “own occupation” phase, however, ends after the first 24 months or two years and is replaced by an “any occupation” provision. To continue receiving long-term disability payments, you must demonstrate that you are unable to perform the tasks of any lucrative vocation for which you are fairly qualified via education, training, or experience.
Long-term disability payments are frequently denied in this situation by insurance companies such as Canada Life. Even if you have a well-documented ailment that prevents you from working in your present employment, the insurance company will sometimes engage a vocational expert to attempt to demonstrate that there are alternative vocations you might undertake, even if you are not now certified to do them.
Don’t give up if Canada Life has declined your application for long-term disability compensation. An appeal may be appropriate. To learn more about your legal possibilities, speak with a certified disability lawyer.
The “Mental and Nervous” Clause
Canada Life avoids paying claims by including a “mental and nervous” language in its policies.
This effectively implies that if it is proven that your impairment was caused or contributed to by a mental or nerve disorder after 24 months of payments have been paid, your benefits will be terminated. This is obviously a significant task and may be highly aggravating, adding to your mental health stress.
The “Benefits Offset” or “Zero-Sum Offset” Clause
Furthermore, most plans have a “benefits offset” clause. This implies that if you get other types of income (such as CPP Disability Payments or Workers’ Compensation Benefits), the amount of your long-term disability benefits will be reduced by the amount of those other benefits. This might make it tough to satisfy your financial obligations, especially if you have a family to support.
If you get benefits in addition to those paid by your insurance company and the amount of those benefits exceeds the entire LTD payment, the insurance company will not pay you anything. This is commonly known as the “zero-sum offset” phrase.
Proving Total Disability
To be eligible for long-term disability compensation, you must be completely handicapped. This implies you are unable to execute the obligations of your specific employment or any other lucrative occupation for which you are properly qualified based on your education, training, or experience.
You will need to present substantial paperwork from your treating physicians outlining the type and severity of your ailment, as well as how it impacts your capacity to work, in order to show complete disability. You will also be required to give proof of your employment experience and credentials.
We can assist you if you have been denied long-term disability payments by Canada Life because they do not deem your condition to be “severe” or “total.” We have a lot of experience dealing with long-term disability claims and appeals, so we know what it takes to secure the benefits you need and deserve.
Contact us today for a no-obligation consultation. We will analyze your case and inform you of your legal choices.
How A “Change of Definition” May Affect Your Denied Canada Life Long-Term Disability Claim
As is customary in long-term disability benefit plans, the definition of “complete disability” changes at the two-year mark, which disability insurance carriers sometimes fail to sufficiently disclose to subscribers.
When an insurance company, such as Canada Life, modifies the definition of “complete disability,” it typically does so to make it more restricted. These transitions can be perplexing and difficult to comprehend, especially if you are already struggling with a significant illness or accident.
A frequent example is switching from “own occupation” to “any occupation.” To continue receiving long-term disability payments, you must demonstrate that you are unable to perform the tasks of any gainful occupation to which you are fairly equipped by education, training, or experience. This means that, even if you have a well-documented condition that has prevented you from working in your current occupation, the insurance company will frequently hire a vocational expert to try to demonstrate that there are other occupations you could perform, even if you are not currently qualified to do them.
If you have been refused long-term disability payments by Canada Life and are unsure about a change in definition, please contact us as soon as possible. We have vast expertise with long-term disability claims and understand how the appeals process works.
What to Do If Your Canada Life Claim Is Denied
First and foremost, don’t panic. You are not alone, and there are choices for you. Others, just like you, are having their LTD claims refused on a daily basis, and regrettably, many people do not seek the assistance of an lawyer because they are unaware that they may.
If your claim is denied, the first thing you should do is seek a copy of the insurance company’s decision letter (if you don’t already have one) as well as a copy of the policy. As soon as you have this information, contact the Findlay Personal Injury Lawyer team. Denial of compensation is sometimes just the first step in a protracted appeals process.
We will work with you to thoroughly evaluate your denial letter. The insurance company should have included the reason(s) for their choice in it. We can begin to design your appeal after we know why your claim was refused.
Contact us right away if you need assistance understanding why your claim was refused or if you are unsure where to begin with your appeal. We provide free consultations and would be pleased to discuss your case and assist you in taking the next steps.
When appealing a denial of long-term disability benefits, you must act swiftly. There are rigorous deadlines in place, and if you miss one, your entire appeal may be jeopardized.
If your original claim is refused, you have the option to file an appeal. The appeals process can be complicated and time-consuming, so having an experienced long-term disability lawyer on your side is essential. We understand the appeals process and will do all in our power to obtain you the benefits you need and deserve. Contact us today for a no-obligation consultation. We will examine your case and inform you of all of your legal choices.
Don’t put it off! We may begin working on your appeal as soon as you call.
Disability Benefits Will Get Harder at the Two-Year Mark with Canada Life
Canada Life is an insurance firm that earns over $50 million in net premiums every year! in net premiums each year! With that kind of money, you’d think they’d be able to cover the long-term disability payouts owed to their policyholders. Regrettably, this is not always the case. In fact, when it comes to receiving long-term disability payments, Canada Life has a reputation for being a tough insurance company to work with.
As if obtaining long-term disability benefits wasn’t challenging enough, policyholders sometimes face additional obstacles when their payments are set to expire after two years.
When it comes to long-term disability insurance, the two-year (24-month) milestone is frequently a make-or-break point for many claims. This is due to the fact that most long-term disability insurance includes clauses that go into effect during this period, making it far more difficult to continue collecting payments.
After two years, Canada Life will review your circumstances and will normally make it more difficult to qualify for LTD coverage. Definitions of what constitutes “disability” tighten, and they grow more stringent with the verification of documentation for your disease.
If you are approaching the two-year mark and are concerned that your long-term disability payments will be terminated, contact us right away. We can assist you in understanding your insurance and the solutions that may be available to you.
How a Lawyer Can Help with Your Canada Life Claim
It is usually preferable to have an experienced lawyer on your side when dealing with insurance firms such as Canada Life. Insurance companies exist to make money, and they will frequently go to any length to avoid paying out claims.
The main line is that you have choices if Canada Life declines your long-term disability claim. You have the right to appeal the refusal and, if required, to take your case to court.
An expert disability lawyer will understand how to interact with the insurance company and fight for the benefits you are entitled to. A qualified lawyer will also be knowledgeable about the appeals procedure and can assist you in navigating this complex system.
Our team at Findlay Personal Injury Lawyers specializes in long-term disability claims. Check out how we can get you the full support you need from your insurance company.
The Difficulty Gathering Evidence for Unseen Conditions
Canada Life frequently denies claims, including symptoms that cannot be observed by doctors, such as mental health disorders, chronic pain, fibromyalgia, anxiety, and depression. This is because gathering proof for these illnesses can be challenging.
You may be denied due to “insufficient medical proof.”
This may be quite irritating, especially if you know your symptoms are real and have a significant impact on your life.
These hidden ailments, particularly mental health disorders, are frequently extremely real and can be as devastating as physical ones. Call us right away if you are suffering from one of these ailments and have been refused benefits. We can assist you in gathering the facts required to substantiate your case and obtain the benefits you deserve.
Frequently Asked Questions about Canada Life Denying Long-Term Disability Claims
Isn’t Canada Life looking out for my best interests?
No, Canada Life is not looking out for your best interests. They are a for-profit insurance firm with the primary purpose of making money. They frequently refuse claims or try to persuade claimants to take less than they are entitled to.
What should I do if my claim is rejected?
If your claim is refused, you have the opportunity to file an appeal. An expert disability lawyer can guide you through the process and offer you the greatest chance of receiving the benefits you are entitled to.
How long does it take to file an appeal?
The appeals procedure can be time-consuming, with final decisions taking months or even years. You should never attempt to negotiate this procedure without the assistance of an expert lawyer.
What are my odds of success in my appeal?
Your odds of winning an appeal are determined by the circumstances of your case. An expert disability lawyer will be able to analyze your case and provide you with a more accurate assessment of your prospects of success.
What if I am unable to work at all?
You may be eligible for CPP Disability payments if you are unable to work at all. An expert lawyer can guide you through the procedure and provide you with the best opportunity of receiving the benefits you require.
Can I obtain assistance if my long-term disability benefits are set to run out?
Yes, you can obtain assistance if your long-term disability payments are due to expire. Call us immediately so we can assist you in understanding your coverage and what choices you may have.
Why is it so tough to work with insurance companies?
Canada Life is one of the world’s largest insurance firms. Despite this, they have a bad reputation when it comes to long-term disability compensation.
This might be due to a variety of factors. For one thing, insurance firms exist to make money. They frequently refuse claims or try to persuade claimants to take less than they are entitled to.
Another reason insurance companies might be tough to work with is because they are familiar with the system. They employ full-time teams of lawyers and adjusters working to dismiss or limit claims. This makes it extremely difficult for claimants to obtain the benefits they want and deserve.
We’re Here When You Need Us Most
When dealing with Canada Life, it is critical to have an experienced disability lawyer on your side. Findlay Personal Injury Lawyers can assist you! We’ve dealt with insurance companies for years and know how to obtain results.
We’re there for you when you need us the most. Call us at 905-522-9799 for a free consultation now. We will study your insurance, evaluate your situation, and inform you of your alternatives. There is no requirement. Don’t put it off until it’s too late; contact us today.