When Insurers Ignore Medical Evidence: Tips from a Long-Term Disability Lawyer to Challenge a Denied Disability Claim

Imagine receiving a denial letter from your insurance company despite submitting extensive medical documentation proving your disability. You’re not alone as this scenario is all too common. When an insurer dismisses clear medical evidence, it can feel both frustrating and unjust. Fortunately, you are not powerless. This guide explains why long-term disability claims get denied and how you can challenge the decision with the help of a qualified long-term disability lawyer.

Why Do Insurers Deny Disability Claims When Strong Medical Evidence Is Provided?

Insurance companies have a duty to assess disability claims fairly, but that doesn’t always happen. Here are some common reasons insurers may reject valid claims:

• Conflicting opinions from insurance doctors: Insurers often rely on assessments from their own doctors, who may never even meet the claimant.
• Surveillance and social media: Insurers may use surveillance footage or social media activity to suggest a claimant is not truly disabled.
• Definition disputes: The definition of “disability” in your policy may be interpreted in the insurer’s favour.
• Incomplete forms or inconsistencies: Even small discrepancies in documentation can be used as justification for a denial.
• Pre-existing condition clauses: Some denials are based on clauses excluding coverage for certain conditions, even when irrelevant.
  

Steps to Take When Your Disability Claim Is Denied

A denial doesn’t have to be the end of your journey. Here's what you can do:

1. Request a Detailed Explanation

Ask your insurer for a written explanation of the denial. Understanding the insurer’s reasoning helps you identify how to respond effectively.

2. Review Your Insurance Policy

Check the definitions, exclusions and appeal timelines. This information will guide your next steps.

3. Gather Additional Evidence

Even if you submitted medical records, consider obtaining:

• A detailed letter from your treating physician
• Functional capacity evaluations
• Psychological assessments, if applicable
  

4. File an Internal Appeal

Most insurance companies allow at least one level of internal appeal. Ensure you meet deadlines and include any new evidence or clarification.

When Should You Consult a Disability Lawyer in Ontario?

If your appeal is denied, or if you suspect the insurer is acting in bad faith, it's time to consult a disability lawyer. A lawyer can:

• Communicate directly with the insurer: This can reduce stress and ensure all legal bases are covered.
• Challenge surveillance or biased assessments: Lawyers know how to counter misleading evidence.

File a lawsuit: If negotiations fail, your lawyer can take your case to court.

How Can Aaron Waxman and Associates, P.C. Help?

We are well versed in handling long term disability claims in Ontario. If your insurer has denied your claim despite strong medical support, our team can:

• Review your insurance policy and denial letter thoroughly.
• Advise you on gathering further medical and occupational evidence.
• Represent you during internal appeals and litigation.
• Advocate for a fair settlement or trial outcome.

We understand how stressful it is to be denied benefits you depend on. Let us take on the legal burden while you focus on your health.

Conclusion

When insurers dismiss medical evidence and deny legitimate disability claims, it’s important not to give up. By understanding your rights and working with a trusted long-term disability lawyer, you can challenge the denial and pursue the benefits you deserve.

Contact Aaron Waxman and Associates, P.C. today for a free consultation. We’ll fight to ensure your rights are respected and your voice is heard.