kotak: 4 roadblocks you may face when you file a disability claim

in the past, risks of disability tended to be physical, from industrial accidents or injuries. but in today’s knowledge-based economy, mental health now takes up the majority of disability risk. in fact, according to sun life, overall disability claims rose 17 per cent from 2016 to 2019, driven mostly by mental health and chronic illness.

a termination of benefits can be successfully challenged

denials based on a pre-existing condition. insurance policies often contain a pre-existing condition clause that disqualifies the applicant from receiving benefits if the coverage was in effect for less than a year before the disability arose. the insurance company investigates the 90-day period before the policy took effect to determine if you have been treated for or taken any medication directly or indirectly related to the condition associated with the claim.

case managers with a hard-line attitude. case managers often treat legitimate claims with suspicion, and once they make a decision, it’s difficult to change their position, even when new information is provided. we often hear from clients that their case managers don’t believe them and make them jump through hoops to supply more and more information for their claim. for some, the constant phone calls and emails are so stressful that their mental health declines even more.

biased medical reports. insurance companies retain independent medical examiners, who frequently decide that claimants are able to work — despite the fact that they have never met or examined them. in many cases, these medical consultants haven’t even received the complete record of medical evidence from all the treating professionals, so their determination is based on limited and incomplete information. the best way to counter a biased medical examiner opinion is by providing solid evidence from medical experts, including from the professionals directly involved in treatment.

insufficient medical evidence. disability claims are often denied on the basis of insufficient medical evidence, which means the insurance company isn’t satisfied that the applicant has provided proof that they can’t work. disability insurers typically invite claimants to provide additional medical reports, but that often leads to a catch-22 situation: no matter what information you provide, you’re repeatedly told that the medical evidence remains insufficient and that you should get more information from your doctor at your own cost.

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.