Legal Assistance

Why was your application for long-term disability denied?

Your sickness may not qualify as a critical illness and be excluded from coverage, such as a benign tumour:

Benefits may be refused for a variety of reasons at different stages of a long-term disability claim. Here are a few typical explanations for why insurers might refuse or discontinue benefits.

Disability coverage requires you to be unable to work. If you have a benign disease that does not interfere with your work, recovery is possible and easy. Insurance companies will not consider you an ideal candidate for long-term disability support.

Actual misrepresentation or failure to disclose

You shouldn’t omit crucial details, including pre-existing medical issues, while buying a critical illness policy or appearing to represent oneself falsely. Your policy would no longer be valid if an insurance company attempted to revoke (void) a policy due to a substantial misrepresentation or nondisclosure.

Not paying your premiums.

If you did not pay your critical illness premiums during the “grace period,” your coverage might no longer be in effect.

Benefits can be refused for various reasons at different stages of a long-term disability claim.

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    Common methods used by insurance companies to determine the authenticity of a case:


    The insurance company has the resources and money to contract with a private investigation firm to carry out surveillance while evaluating your claim. Internet searches, social media searches, and video and photo surveillance are all possible. This frequently happens without your knowledge. Surveillance will be of little or no use to the insurer as long as you refrain from engaging in activities that you have been medically warned against performing.  Insurance companies typically request that surveillance be done around birthdays, holidays and during the summer when people are outside and more active.  Surveillance is also more frequently done when the claim is approaching its second anniversary.

    Using social media

    Insurance companies are particularly interested in social media activity regarding claims for psychiatric diseases like depression. Insurance companies are interested in social media since it can be used to cast doubt on a person’s credibility. Keep in mind that your insurance provider can find your own content in a Google search.  Posting images of yourself on Facebook, Instagram and other internet sites is not recommended if you have a disability claim or lawsuit.  It doesn’t matter if your account is private.  Insurance companies hire social media private investigators to locate your data and photos.

    Rehabilitative and medical care

    The rehabilitation clause found in most long-term disability policies essentially states that LTD payments will be paid as long as you receive the right care for your condition and are being monitored by the right doctor. Regularly attending therapies or engaging in the required treatment strengthens your case and demonstrates your willingness to take part in your rehabilitation.

    ​Attending doctor’s appointments, following treatment advice, and taking prescribed medications will help document to your insurance provider that you have a legitimate medical problem.

    Absence of medical proof

    Sometimes the phrase “Insufficient Evidence to Support Condition” means that the insurance provider disputes the diagnosis of your disability made by your doctors. As a result, your claim might have been denied because an internal medicine consultant who evaluated your application did not think your medical condition was severe enough to meet the requirements for Long Term Disability (LTD) payments.

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