long term disability claim denied Toronto Employment Lawyer

 

Have You Ever Had a LTD Claim Denied?

This is a case about “Jane Doe” whose Long Term Disability Claim (LTD) was denied after having worked for an employer for nearly 16 years before she became ill and could no longer be able to work.

She suffered from musculoskeletal fibromyalgia and osteoarthritis. Her symptoms were fatigue and chronic joint aches and pain. Her condition was very severe and her job was physically demanding and this left her constantly exhausted.

 

Employer Could Not Accommodate Her Illness and Restrictions

Ms. Doe’s employers were not sympathetic to her situation and after a while they did not want to deal with her.  Her employer denied the health benefits she needed and simply said that they could not accommodate her illness and restrictions.

Without much other choice, Jane Doe decided to apply for Long Term Disability, a benefit that was part of her remuneration package as an employee of that company and which assured a portion of her salary would be paid out to her if she became disabled for the long term, while working for this employer.

The case was straight forward, or so she believed.  She filed this LTD application with the group disability insurance company in September 2013 and a month later she had a telephone interview with the insurer.  She was advised that she would be informed of their decision in writing in a few a months.

 

 Insurance Company Denies Claim

After waiting several months with no further news from the insurance company, and no income, she finally heard back from them in March 2014.  The insurance company advised that her Long Term disability claim was denied because she did not qualify. The reason the Insurance Company provided for this denial of benefits was that their findings did not determine her condition to be so severe that she could not perform her job.

Their findings did not determine her condition to be so severe that she could not perform her job

This was totally contrary to the opinion of the physician who had actually treated her!

long term disability claim denied

Have you had claims denied by your Insurance policy?

And this is when Ms. Doe approached Lecker & Associates for help. We reviewed the insurance company’s decision, of course disagreed with it and immediately appealed the denial of her benefits as laid out in the policy.

As expected, in May 2014 she was once again denied her LTD benefits. This time the insurance company stated that their assessment of her symptoms, nature and frequency of treatment, restrictions and limitations did not meet the definition of disability under the group policy: a determination that was obviously contrived, self-serving and inconsistent with medical assessments by professionals in the field of medicine.

 

Physician LTD Certified Findings

In fact her physicians had certified that she suffered from chronic fibromyalgia and osteoarthritis which are chronic and constant and she was therefore was not able to perform the duties of her job.

 Physicians had certified that she suffered … from chronic and constant pain

We once again appealed and attached additional medical information. On August 2014 her disability claim was denied again for a third time and the insurance company continued to state that her medical evidence did not support a disability that would preclude her from work duties.

 

 LTD Court Preceedings

We initiated court proceedings on behalf of Ms. Doe and it was only at this stage that the insurer began to take this application more seriously. They realized their case was weak and fearing a court defeat and related high settlement costs, they agreed to a mediation. Within three months of our intervention, the long term disability claim was successfully settled after being denied multiple times.

 

Has Your Employer Refused to Provide Health Benefits?

In our 30 years of practice specializing as Toronto disability claim lawyers, we unfortunately see this scenario play out almost on a weekly basis. Long Term Disability benefits can get denied multiple times and are often only paid out to those who persist. The majority of LTD claims are denied, even when those claims are legitimate.

 Are you facing a similar situation?  If so, call us right away.

With a combination of legal and medical knowledge, our team has developed the unique skill set required to fight the insurance companies at their own game.  We can help.

 

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