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  • Priashna Singh – Reasons why insurance companies deny long-term disability claims?

    September 17, 2020

    There are several reasons why an insurance company would deny a long-term disability claim. They include:

    1. Insufficient documentation, especially medical-related

    The rule that exists when you want to submit a claim for long-term disability benefits is to give complete and thorough medical documentation. This documentation needs to show the condition you have that renders you incapable of working. Medical records are the backbone that you need to hold the disability claim together. If you cannot provide all the subjective, objective, and pertinent medical records required by the insurer, your claim is denied. You may not have the documentation because you failed to get it, or you did not get the necessary treatment for them to be generated. 

    In such an instance, the insurance company can simply state that medical documents you have given do not support the claim that you are incapable of working due to a disability. There are instances where the company may take advantage of the situation and fail to explain why the said documents are not sufficient, even after they are produced. A treatment provider and doctor should be in a position to support and verify the disability claim to make it easier for you to access the policy. 

    • You are not entirely disabled.

    There are regulations set out by relevant bodies that aim at defining the meaning of the disabled in the context of getting benefits. In broad terms, most plans define it as an accident or health-related type of injury that makes it hard or incapacitates you from handling some important duties related to your occupation. It all lies in the details. It is important to review the policy you are currently using to clearly define the term disabled, even before you place a claim. A lawyer can help you review the group certificate or policy before you make the initial claim. 

    Insurance companies sometimes use the term not completely disabled to avoid payouts. However, the term disabled does not necessarily mean that you are in a coma or suffer from paralyses or stroke. It also does not mean that you have undergone an intense brain injury. It simply means that you are limited in handling many aspects of the occupation or any other kind of occupation suitable for the kind of education, experience, and training you have. Our long-term disability claim lawyer in Brampton can help you figure out what is needed. We can give you the guidance that you actually need to get a payout. 

    • You can handle the work.

    Some people get cut off just before they hit the two-year mark of the policy. This is because the company assumes that they can simply get into a different occupation. This may not be the case, and it may not be what the doctor advised. When you get a skills assessment that has been conducted by the insurer, and it is not the same as what the doctor advised, it is time to contact our long-term disability claim lawyer in Brampton

    • Dispute on the severity of the condition

    Different health conditions get severe as time progresses. There are instances when they get disabling at a certain point in the lifespan of the condition. This is another reason why the company may not agree to honor claims and pay off. They may disagree with the assessment given by the medical practitioner regarding how severe the condition is. These kinds of disputes are usually very subjective. For example, when the main issue is pain, a condition can be put under many scrutinies and can face a lot of opposition. There are also instances where the claims are self-reported, like when someone has fibromyalgia, chronic fatigue, and migraines. Such issues have very limited benefit periods of up to two years. This is one of the reasons why thorough and accurate claim documentation is so critical. It is also one reason you should consult us for assistance in these matters since we know everything about filing claims. 

    • Insurer investigation

    As earlier noted, insurers are also in the business to make a profit. This means they are not going around paying people off blindly and without considerations. Long-term disability benefits involve quite significant payouts. This is why insurance companies try hard to limit exposure as far as finances are concerned. It is common for insurers to send their investigators to the community or homes to find out more about the disabled person and whether the claim they have filed is indeed true. This leads to surveillance of the claimants, and it involves recording videos while going about your daily duties. 

    They may show evidence of you doing your normal day-to-day activities that could be inconsistent with the claims made. The main issue with the collection of this kind of evidence is that it can be misinterpreted. You need to talk to us about what you should and should not do in public once you have submitted a claim. Our long-term disability claim lawyer in Brampton can advise you on what to expect and what you should avoid doing. 

    Once you have placed a claim and say you cannot complete certain tasks, the insurance company could send out their videographers just to follow you and take videos of you doing some things you claimed you could not do. The videographers can exaggerate and misinterpret the evidence to favor the company and avoid payouts.  Social media is yet another area where you can be misinterpreted. Most users depict live versions that are almost too good to be true. People want a curated kind of life to show off to the world. When you are seeking long-term disability compensation, this kind of display can work against you. This is because investigators can go through all channels, seeking evidence that can be interpreted to mean that the claims made are illegitimate. Therefore, the claimant should stay off social media as much as possible, especially when making a claim. 

  • Priashna Singh – Reasons why insurance companies deny long-term disability claims?

    September 17, 2020

    There are several reasons why an insurance company would deny a long-term disability claim. They include:

    1. Insufficient documentation, especially medical-related

    The rule that exists when you want to submit a claim for long-term disability benefits is to give complete and thorough medical documentation. This documentation needs to show the condition you have that renders you incapable of working. Medical records are the backbone that you need to hold the disability claim together. If you cannot provide all the subjective, objective, and pertinent medical records required by the insurer, your claim is denied. You may not have the documentation because you failed to get it, or you did not get the necessary treatment for them to be generated. 

    In such an instance, the insurance company can simply state that medical documents you have given do not support the claim that you are incapable of working due to a disability. There are instances where the company may take advantage of the situation and fail to explain why the said documents are not sufficient, even after they are produced. A treatment provider and doctor should be in a position to support and verify the disability claim to make it easier for you to access the policy. 

    • You are not entirely disabled.

    There are regulations set out by relevant bodies that aim at defining the meaning of the disabled in the context of getting benefits. In broad terms, most plans define it as an accident or health-related type of injury that makes it hard or incapacitates you from handling some important duties related to your occupation. It all lies in the details. It is important to review the policy you are currently using to clearly define the term disabled, even before you place a claim. A lawyer can help you review the group certificate or policy before you make the initial claim. 

    Insurance companies sometimes use the term not completely disabled to avoid payouts. However, the term disabled does not necessarily mean that you are in a coma or suffer from paralyses or stroke. It also does not mean that you have undergone an intense brain injury. It simply means that you are limited in handling many aspects of the occupation or any other kind of occupation suitable for the kind of education, experience, and training you have. Our long-term disability claim lawyer in Brampton can help you figure out what is needed. We can give you the guidance that you actually need to get a payout. 

    • You can handle the work.

    Some people get cut off just before they hit the two-year mark of the policy. This is because the company assumes that they can simply get into a different occupation. This may not be the case, and it may not be what the doctor advised. When you get a skills assessment that has been conducted by the insurer, and it is not the same as what the doctor advised, it is time to contact our long-term disability claim lawyer in Brampton

    • Dispute on the severity of the condition

    Different health conditions get severe as time progresses. There are instances when they get disabling at a certain point in the lifespan of the condition. This is another reason why the company may not agree to honor claims and pay off. They may disagree with the assessment given by the medical practitioner regarding how severe the condition is. These kinds of disputes are usually very subjective. For example, when the main issue is pain, a condition can be put under many scrutinies and can face a lot of opposition. There are also instances where the claims are self-reported, like when someone has fibromyalgia, chronic fatigue, and migraines. Such issues have very limited benefit periods of up to two years. This is one of the reasons why thorough and accurate claim documentation is so critical. It is also one reason you should consult us for assistance in these matters since we know everything about filing claims. 

    • Insurer investigation

    As earlier noted, insurers are also in the business to make a profit. This means they are not going around paying people off blindly and without considerations. Long-term disability benefits involve quite significant payouts. This is why insurance companies try hard to limit exposure as far as finances are concerned. It is common for insurers to send their investigators to the community or homes to find out more about the disabled person and whether the claim they have filed is indeed true. This leads to surveillance of the claimants, and it involves recording videos while going about your daily duties. 

    They may show evidence of you doing your normal day-to-day activities that could be inconsistent with the claims made. The main issue with the collection of this kind of evidence is that it can be misinterpreted. You need to talk to us about what you should and should not do in public once you have submitted a claim. Our long-term disability claim lawyer in Brampton can advise you on what to expect and what you should avoid doing. 

    Once you have placed a claim and say you cannot complete certain tasks, the insurance company could send out their videographers just to follow you and take videos of you doing some things you claimed you could not do. The videographers can exaggerate and misinterpret the evidence to favor the company and avoid payouts.  Social media is yet another area where you can be misinterpreted. Most users depict live versions that are almost too good to be true. People want a curated kind of life to show off to the world. When you are seeking long-term disability compensation, this kind of display can work against you. This is because investigators can go through all channels, seeking evidence that can be interpreted to mean that the claims made are illegitimate. Therefore, the claimant should stay off social media as much as possible, especially when making a claim. 

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