Ask a Vancouver Lawyer: My Long-Term Disability Claim Was Denied…What Next?

If there has been a denial of your claim for long-term disability, our lawyers at Bronson Jones & Company LLP in the Lower Mainland can help. It is exceptionally challenging and difficult to struggle with a disability while also fighting with the insurance company to get the benefits you deserve.


It is unfortunately very common for valid disability claims to be denied by the insurance company – but that denial does not mean you should give up on your claim! Our long-term disability lawyers in Vancouver offer a free initial consultation to discuss what to do next. 

This article will discuss some of the common reasons for denial of insurance coverage and how our lawyers can help alleviate the pressure of dealing with the insurance company.


Insurance company decides you don’t meet terms of the insurance policy

In many cases, the denial of long-term disability benefits essentially boils down to a contractual dispute--the contract being the insurance policy. Long-term disability claims are denied because the insurance company decides that you do not meet the eligibility requirements set out in your disability benefit policy. The terms and definitions in a disability policy can be extremely technical and confusing to understand, and this can be compounded if your disability causes cognitive impairment and / or overwhelming physical pain. Our experienced long-term disability lawyers understand the language of insurance policies and have the skills to challenge the insurance company’s interpretation and application of the policy.


Coverage denied due to lack of medical evidence

Also extremely common is a denial based on lack of proof of disability to support the claim that you are unable to work. Insurance companies frequently deny claims on the basis that there is no objective medical evidence. The Vancouver long-term disability lawyers at Bronson Jones & Company LLP have seen this arise in all types of claims, but in our experience, it happens most often in claims involving fibromyalgia, chronic pain, chronic fatigue syndrome, or psychological illnesses such as depression and anxiety. These types of illnesses can be difficult to prove because they are not evident on an X-ray or in a blood test. Our team of long-term disability lawyers can gather evidence to substantiate your illness or condition, and if necessary, we can build your claim by referring you to a medical and / or occupational specialist.


Should I bring an internal appeal or start a lawsuit?

If your claim for long-term disability benefits is denied, the insurance company may give you the option of bringing an internal appeal – in other words, a reconsideration of your claim by the insurance company. In some situations, this is an acceptable option (for example, if your claim was denied in the initial stages because specific information was needed from your doctor). In other cases, you may not know what other information the insurance company needs from you or your doctor to be satisfied of your disability. It can be difficult to know what to say or do to convince the insurance company to reverse its denial of your claim. The lawyers at Bronson Jones & Company can help.

Internal appeal processes often have several levels and can drag on for months or even years. In many cases, going the internal appeal route simply delays the inevitable and the insurer refuses to reverse its denial of coverage. As such, the internal appeal route is not advisable in every case, nor is it always a necessary step before you can start legal proceedings. Factors such as the reason for the denial, how long your claim has been ongoing, and the wording of the policy itself must be considered to determine whether you should exhaust the internal appeal process or go straight to commencing a lawsuit against the insurance company. It is very important to note that bringing an internal appeal does not stop the clock from running on the deadline for bringing a lawsuit.


First step after your long-term disability claim is denied

When your claim is initially denied, your first step should be to seek legal advice from one of our long-term disability lawyers in Vancouver. We can: 

• Review the language of the insurance policy to help you understand the reason for the denial of coverage and how the denial can be challenged;
• Evaluate whether you should proceed by internal appeal or lawsuit against the insurance company;
• Advise of the different deadlines that apply to file an internal appeal and /or sue he insurance company;
• Guide you through the internal appeal process;
• Work with your doctor or other treating professionals to obtain the medical evidence required to substantiate your claim;
• Negotiate on your behalf to secure settlement or an agreement to pay disability benefits; and
• Commence legal proceedings against the insurance company if necessary. 


Legal Guidance & More From Our Vancouver Long-Term Disability Lawyers

Bronson Jones & Company lawyers have trial experience and extensive experience in negotiating fair settlements for long-term disability claims. We have also developed a wide network of medical and occupational specialists, therapists, rehabilitation specialists, and others to help you recover, and to properly build your claim. Reports from these experts may be essential in the development of your case. If you or a loved one requires assistance with a long-term disability claim, call any of the 13 Bronson Jones locations in the Lower Mainland for our expertise and advice.

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