how doctors play an integral role in disability claim approvals

it should come as no surprise that insurance companies most often deny disability claims due to insufficient medical evidence.

by nainesh kotak

published sep 10, 2024

3 minute read

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3 minute read

join the conversation

good communication and rapport with your doctor can help you build a stronger, successful disability claim and get you the support you need. getty images

doctors play an integral and vital role in disability claim approvals. doctors’ medical expertise and documentation are pivotal in proving the extent of your disability. it should come as no surprise, then, that insurance companies most often deny disability claims due to insufficient medical evidence. however, it’s important to remember that you have a right to dispute an insurance company’s decision. if you are feeling alone or too overwhelmed to start the process of claiming disability benefits, know that — statistically — many canadians have been in the same situation.

the 2022 canadian survey on disability showed that 27 per cent of canadians aged 15 years and older, or eight million people, had one or more disabilities that limited them in their daily activities. the rate of disability in canada has actually increased by five percentage points since 2017.

in 2022, nearly one-quarter (24 per cent) of working-age adults (ages 25 to 64) had a disability in 2022, an increase of four percentage points over 2017, when the rate was 20 per cent.

any canadian claiming disability insurance benefits will soon learn that as part of the application process, they will need their doctor to complete a form known as the attending physician’s statement. this provides the insurance company with specific medical information about a claimant’s condition as well as the expected time to recover.

it’s arguably the most important form. it is a document from your healthcare provider detailing your medical condition, the treatment you’re receiving, and how it affects your ability to perform your job.

this document is often the main one that the disability insurer will use to determine whether or not you qualify for benefits. it’s your physician’s expert opinion that can tip the balance in your favour.

that’s why it’s always important to get an ally, in your family doctor or treating physician, not only to help get treatment. these are the people who are going to fill out the forms for your claim. if you don’t have a family doctor, you may have to consider going to a doctor at a walk-in clinic or you can perhaps turn to a social worker, if you have a mental health issue.

if your condition takes a turn for the worse or one of your health professionals recommends a new course of treatment, it’s important to pass on to your insurer the medical records and reports that set out those opinions or back up the assessments of specialists.

you should also let your long-term disability insurance provider know when you begin seeing a new health practitioner and update them on progress after receiving any therapies or procedures, such as surgery.

an insurance dispute over long-term disability benefits can sometimes be resolved by fairly straight-forward steps, such as providing the required objective medical evidence to substantiate that your symptoms prevent you from performing the essential aspects of your job.

medical evidence of your reported symptoms, diagnosis and treatment is the most important facet of your claim. that’s why good communication and rapport with your doctor can help you build a stronger, successful disability claim and get you the support you need.

ultimately, everybody wins when a once-disabled worker recovers to the point that they feel ready to go back to the workplace, as long as their doctors agree it’s safe.

nainesh kotak, is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he also serves as the chair of the long-term disability section of the ontario trial lawyers’ association.