Has Manulife Denied Your Long-Term Disability Benefits?

LTD Claim Denied by Manulife?

If you’ve been denied long-term disability benefits by Manulife, you’re probably feeling frustrated and overwhelmed. After all, you’ve been paying into your policy for years, and now when you need the coverage the most, the insurance company is telling you that you’re not eligible. 

Don’t give up hope just yet! In many cases, denial of long-term disability benefits is simply the first step in a lengthy appeals process. Manulife, like many insurance companies, does not like to pay claims. They will often give policyholders the runaround in the hopes that they will simply give up and go away. 

You don’t have to go through this process alone! At Findlay Personal Injury Lawyers, we take a team approach to the legal process. Our staff, case managers, and lawyers have the collective medical knowledge necessary to put together a strong appeal on your behalf. 

We will review your denial letter and assess whether or not you have a case. If we believe you do, we will put together a plan of action that includes gathering the necessary medical evidence and witnesses to support your claim. 

We understand how stressful this time can be and have years of experience dealing with insurance companies like Manulife. We know their tactics, and we know how to fight back. 

With the help of a qualified disability lawyer, you may be able to get the benefits you need and deserve. If you would like more information about our fees and services, please call us at 905-522-9799 or visit one of our locations.

Long-term Disability Claim Denied by Manulife

The majority of valid long-term disability (LTD) claims in Ontario are denied by insurance providers. According to figures from the industry, almost 60% of all long-term disability claims are rejected annually. 

You will usually receive a letter from Manulife notifying you that your long-term disability claim has been denied and inviting you to appeal the insurance company’s decision. In order to prevent a protracted court struggle, this is done in the hopes that the insurance company can handle things directly with the applicant. 

Before continuing with the appeals procedure, it’s crucial to know and understand your rights. Dealing with insurance providers without a lawyer is challenging and, in most cases, not advisable. A lawyer who specializes in long-term disability claims will help you appeal the insurance company’s decision and, if necessary, take your case to court.

What Happens If My Long-Term Disability Claim Is Denied?

When you first apply for long-term disability benefits, the insurance company will request that you provide extensive information about your medical condition. The insurance company will also have its own doctors review your file. In some cases, the insurance company may even request that you attend an independent medical examination (IME) with one of their doctors. 

The IME is important because it allows the insurance company to get a second opinion on your condition and how it affects your ability to work. However, it’s important to note that the IME is not binding on the insurance company. In other words, even if the IME doctor says you’re disabled, the insurance company can still deny your claim. 

Appealing A Denied LTD Claim with Manulife

There are several grounds on which an appeal can be based. For example, if your claim was denied because Manulife said your condition is not covered by the policy, an appeal can be based on the argument that the condition is, in fact, covered. Another common reason for denial of long-term disability benefits is that Manulife says your condition is not “severe enough.” An appeal can be based on the argument that the insurance company’s definition of “severe” is too restrictive. 

To qualify for long-term disability benefits under most individual or employee long-term disability policies, the onus is on you to prove that you suffer a total disability during the qualifying period and the first 24 months or two years of long-term disability. 

The “Own Occupation” Clause

Most long-term disability policies contain an “own occupation clause” during the first 24 months (2 years) of long-term disability, 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 some other type of work. 

However, after the first 24 months or two years have passed, the “own occupation” period ends and is replaced by an “any occupation” clause. This means that to continue receiving long-term disability benefits, you must prove that you are unable to perform the duties of any gainful occupation for which you may be reasonably suited by education, training or experience. 

This is often where insurance companies such as Manulife deny long-term disability benefits. Even if you have a well-documented condition that has prevented you from working in your particular occupation, the insurance company will often hire a vocational expert to try to show that there are other occupations you could perform, even if you are not currently qualified to do them. 

If your claim for long-term disability benefits has been denied by Manulife, don’t give up. There may be grounds for an appeal. Speak with a qualified disability lawyer to learn more about your legal options. 

The “Mental and Nervous” Clause

One way Manulife avoids paying claims is to place what is called a “mental and nervous” clause in their policies. 

What this essentially means is that after 24 months of benefits have been paid, if it’s determined that your disability was caused or contributed to by a mental or nervous condition, your benefits will be terminated. This can obviously present a serious challenge and be extremely frustrating, adding to your mental health stress. 

The “Benefits Offset” or “Zero-Sum Offset” Clause

In addition, most policies also contain a “benefits offset” clause. This means that if you are also receiving other forms of income (such as CPP Disability benefits or Workers’ Compensation Benefits), your long-term disability benefits will be reduced by the amount of those other benefits. This can make it very difficult to make ends meet, especially if you have a family to support. 

If you’re receiving benefits outside of what your insurance company is paying you, and the total of those other benefits equal more than the total LTD payment, the insurance company will not pay you anything. This is often referred to as the “zero-sum offset” clause. 

Proving Total Disability

To qualify for long-term disability benefits, you must prove that you are totally disabled. This means that you are unable to perform the duties of your particular occupation or any gainful occupation for which you may be reasonably suited by education, training or experience. 

In order to prove total disability, you will need to provide extensive documentation from your treating physicians detailing the nature and severity of your condition, as well as how it affects your ability to work. You will also need to provide documentation of your work history and qualifications. 

If you are denied long-term disability benefits by Manulife because they don’t consider you to have a “severe” enough condition or a “total disability,” we can help. We have extensive experience handling long-term disability claims and appeals, and we know what it takes to get the benefits you need and deserve. 

Contact us today for a free consultation. We will review your case and explain your legal options.

How A “Change of Definition” May Affect Your Denied Manulife Long-Term Disability Claim

As is usual in long-term disability benefit plans, there is typically a change in the definition of “total disability” at the two-year point, which disability insurance providers often fail to adequately communicate to policyholders. 

When an insurance company such as Manulife changes the definition of “total disability,” it is usually to a more restrictive one. These changes can be very confusing and difficult to understand, especially when you are already dealing with a serious illness or injury. 

For example, a common change is from “own occupation” to “any occupation”. This means that, in order to continue receiving long-term disability benefits, you must prove that you are unable to perform the duties of any gainful occupation for which you may be reasonably suited by education, training or experience. This means that even if you have a well-documented condition that has prevented you from working in your particular occupation, the insurance company will often hire a vocational expert to try to show that there are other occupations you could perform, even if you are not currently qualified to do them. 

If you have been denied long-term disability benefits by Manulife and are unsure about a change of definition, call us right away. We have extensive experience handling long-term disability claims, and we know how to navigate the appeals process.

What to Do If Your Manulife Claim Is Denied

First, don’t panic. You are not alone, and there are options available to you. Others, just like you, are being denied their LTD claims every single day, and unfortunately, a lot of people don’t seek the help of a lawyer because they don’t know that they can. 

If your claim has been denied, the first thing you should do is request a copy of the insurance company’s decision letter (if you don’t have it yet), as well as a copy of the policy itself. Once you have this information, call the Findlay Personal Injury Lawyer team immediately. In many cases, denial of benefits is simply the first step in a lengthy appeals process. 

We will work with you to review your denial letter carefully. In it, the insurance company should have stated the reason(s) for their decision. Once we know why your claim was denied, we can start to build your appeal. 

If you need help understanding why your claim was denied or are not sure where to start with your appeal, contact us today. We offer free consultations, and we would be happy to review your case and help you take the next steps. 

It is very important that you act quickly when appealing a long-term disability benefits denial. There are strict deadlines in place, and if you miss one, it could jeopardize your entire appeal. 

If your initial claim is denied, you have the right to appeal the decision. The appeals process can be complex and time-consuming, so it is important to have an experienced long-term disability lawyer on your side. We know the ins and outs of the appeals process, and we will do everything we can to help you get the benefits you need and deserve. Contact us today for a free consultation. We will review your case and explain all of your legal options. 

Don’t wait! The sooner you call, the sooner we can start working on your appeal.

Disability Benefits Will Get Harder at the Two-Year Mark with Manulife

Manulife is an insurance company taking in over $40 billion in premiums every year! With that much income, you would think they would be able to pay the long-term disability benefits they owe to their policyholders. Unfortunately, that is not always the case. In fact, Manulife has a reputation for being a difficult insurance company to deal with when it comes to getting your long-term disability benefits. 

As if the process of getting long-term disability benefits wasn’t already difficult enough, policyholders often face even more challenges when their benefits are scheduled to end after the two-year mark. 

The two-year (24-month) mark, when it comes to long-term disability insurance, is often a make-or-break point for many claimants. This is because most long-term disability policies have clauses that take effect at this time, which can make it much more difficult to continue receiving benefits. 

At the end of two years, Manulife gets to readdress your situation and will typically make it harder to qualify for your LTD benefits. Definitions of what counts as being “disabled” tighten, and they become stricter with the proof of documentation of your condition. 

If you are facing the two-year mark and are worried about your long-term disability benefits being cut off, call us today. We can help you understand your policy and what options may be available to you.

How an Lawyer Can Help with Your Manulife Claim

When it comes to dealing with insurance companies like Manulife, it is always best to have an experienced lawyer on your side. Insurance companies are in the business of making money, and they will often do whatever they can to avoid paying out claims. 

The bottom line is that if Manulife denies your long-term disability claim, you have options. You can appeal the denial and, if necessary, take your case to court. 

An experienced disability lawyer will know how to deal with the insurance company and fight for the benefits you deserve. In addition, a good lawyer will also be familiar with the appeals process and can help you navigate 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

Claims are often denied by Manulife when they consist of symptoms that cannot be seen by doctors, such as fatigue, mental health conditions, chronic pain, fibromyalgia, anxiety, and depression. This is because it can be difficult to gather evidence for these types of conditions. 

You may receive a denial of “insufficient medical evidence“. 

This can be very frustrating, especially if you know that your symptoms are real and are having a major impact on your life. 

These unseen conditions, especially mental health issues, are often very real and can be just as debilitating as physical conditions. If you are suffering from one of these conditions and have been denied benefits, call us today. We can help you gather the evidence you need to prove your case and get the benefits you deserve. 

We’re Here When You Need Us Most

If you are dealing with Manulife, it is important that you have an experienced disability lawyer by your side. The team at Findlay Personal Injury Lawyers can help! We have years of experience dealing with insurance companies, and we know how to get results. 

We’re here when you need us most. Call us today for a free consultation at 905-522-9799. We will review your policy, assess your case, and let you know what options are available to you. There is no obligation. Don’t wait until it’s too late – call us today! 

Get the financial support you need for optimal recovery with Findlay Personal Lawyers

Findlay Personal Injury Lawyers – Hamilton 
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(905) 522 9799

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