DISABILITY CLAIM DENIALS

Insurance Claim Denials / Disability claim denials

Disability insurance policies are ‘peace of mind’ contracts that pay you a portion of your lost income if you become “disabled” from working as a result of illness or injury.

These can be individual/private plans or policies (paid for privately by the person wishing to be insured) or group plans or policies (paid as part of your employment package).

The contract or policy will set out the definition of disability. Contractual definitions are always open to interpretation. Generally you will qualify for benefits if you are not able to do all, or substantially all, of the duties of your current occupation – sometimes referred to as the “own occupation” definition. Many policies will also change the definition of disability a set period (usually 2 years) to that of  “any occupation” – meaning you have to prove that you are not only disabled from working in your own occupation but also in ANY occupation. Again this is open to interpretation – the courts have held that “any occupation” means any occupation similar in status and pay to your former occupation.

Generally, you will be considered disabled if the injury or illness is such that common sense requires you to stop working so you can focus on getting better.

Disability claim cases are often denied for “lack of medical evidence”. Our disability claim lawyers have successfully resolved denied claims by bringing forth the medical evidence required to prove the disability as defined under the policy.

Even in circumstances where the insurance company permits you to appeal the decision, it is still important to seek legal advice from a disability claim lawyer for the following reason:

YOU ONLY HAVE A LIMITED TIME WITHIN WHICH TO TAKE LEGAL ACTION. THIS IS CALLED A LIMITATION PERIOD. WHEN THE TIME LIMIT BEGINS TO RUN WILL DEPEND ON THE FACTS OF YOUR CASE.

Time limits are not the same for every policy and every circumstance and that is why it is essential to get legal advice to know what time limits apply in your particular circumstance.

If an insurer has wrongfully denied you benefits, you may have no alternative but to take legal action.

Read more about the types of disability claims commonly denied.

Read more about the denial of claims for depression and anxiety.

Understanding Disability Insurance Video Series

Understanding your disability insurance coverage and the nuances around your policy is tough to interpret for anyone outside of the industry. Many times, cases are heavily dependant on obtaining medical evidence to prove the disability by the policy in question. At Wirsig Matheos, we represent clients who have been denied benefits and can help you navigate the complexities of your claim.

Below are some short clips to help you understand the disability insurance claim process.

We encourage you to contact us to discuss whether we can be of assistance when disputing your case.