The Disability Claim Playbook: How to Stay Ahead of Insurance Tactics
When life takes an unexpected turn—whether through illness, injury, or a mental health challenge—the last thing you should worry about is how to make ends meet. Long-term disability (LTD) benefits are designed to be your lifeline, giving you the financial stability you need while you focus on healing. But if you’ve ever tried dealing with an insurance company, you know it’s not always that simple. Claims get delayed, denied, and questioned, leaving many people frustrated and overwhelmed at a time when they’re already struggling.
Knowing how to navigate the process effectively can make the difference between a smooth claim and a stressful denial.
This brief guide will walk you through every key step —from building a strong claim to overcoming insurance tactics—so you can get the benefits you’re entitled to and focus on what matters: your recovery.
Start Strong: Preparation is Key
A successful claim begins with understanding the fine print of your LTD policy. Every policy outlines unique requirements, including timelines and definitions of disability. Pay attention to key factors such as:
Waiting Periods (Elimination Periods): Most policies impose a 90 to 120-day waiting period before benefits start. During this time, you may need to rely on sick leave, short-term disability, or Employment Insurance (EI) sickness benefits.
Definition of Disability: Many policies initially require you to prove that you cannot perform your current job ("own occupation"). However, after 24 months, they often switch to the more difficult "any occupation" standard, meaning you must show you are unable to work in any role for which you are qualified.
Gathering Strong Medical Evidence
Comprehensive medical documentation is the foundation of your claim. Your insurer needs to see clear proof that your condition prevents you from working. This means submitting detailed reports from your healthcare providers explaining your diagnosis, symptoms, treatment, and the specific ways your condition limits your ability to work.
Stay organized by keeping a record of every appointment and following your doctor’s recommendations carefully. Skipping treatments or not following medical advice can raise red flags with insurers, leading to a denied claim.
Submitting a Complete and Accurate Application
When it’s time to submit your claim, make sure all forms are filled out correctly and every required document is included. Even minor errors or missing information can lead to delays or outright denials. If your claim is tied to a group insurance policy through your employer, ensure their statements align with your application to avoid inconsistencies that could cause issues.
Once you’ve submitted your claim, be prepared for follow-up requests from the insurer, such as requests for updated medical records or clarifications.
Anticipating Insurance Tactics
Insurance companies may use tactics to limit or deny claims. Some common strategies include:
Surveillance: Insurers may monitor your activities to look for evidence that contradicts your claim.
Independent Medical Examinations (IME): You may be required to attend an IME with a doctor chosen by the insurer.
Handling a Denied Claim: Don’t Give Up
Many legitimate LTD claims are initially denied. Insurers might argue that your condition isn’t severe enough or that you are fit to work in some capacity. If your claim is denied, carefully review the denial letter to understand the insurer’s reasons.
Most policies allow for appeals. Use the appeal process as an opportunity to gather additional evidence or clarify any misunderstandings. With persistence and the right documentation, many denied claims are eventually approved.
We Have Over 50 Years of Experience - We’re Here to Help
Navigating the LTD process can be overwhelming, especially when insurers put up roadblocks. With over five decades of experience in personal injury law, we understand how to overcome these challenges and secure the benefits you deserve. If you need guidance or support, we’re ready to help every step of the way. We’ll take the legal burden off your shoulders so you can focus on what matters most—your recovery.
