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Can My Disability Claim Get Reviewed If It Has Gotten Worse?

It’s unfortunately common for insurance companies to deny long term disability claims. It’s also very common for insurance companies to decide to terminate benefit coverage. Can your long-term disability (“LTD”) claim be reviewed if your illness or personal injury has gotten worse after your claim is denied or your benefits are cut off?

Long term disability lawyer

Review of decision to deny or terminate your LTD benefit claim

You can request a review of the insurance company’s decision to deny or terminate your LTD claim. Legitimate claims are denied for many reasons, including mistakes in the application or insufficient medical evidence to support that you are disabled. Misunderstanding of the nature of your illness or personal injury is another commonly cited reason for LTD claim denials.

Plain and simple, the insurance company may not understand your medical condition or how it prevents you from working. Symptoms can be unpredictable. This is especially true for certain types of chronic illnesses or long-term personal injury. Relapses are when symptoms worsen; remissions are periods when symptoms lessen or improve completely. Chronic illnesses such as multiple sclerosis (“MS”), rheumatoid arthritis (“RA”), Sickle cell anemia, Epilepsy, and Asthma can go into remission. Symptoms of psychological illnesses such as anxiety, depression, and post-traumatic stress disorder (PTSD) can also fluctuate.

Remission is usually only temporary, but the insurance company will seize on that period of remission as an excuse to deny or terminate benefits.

Options if your disability claim is denied or terminated

If you’ve experienced a worsening or significant change in your medical condition in the time since your LTD benefit claim has been denied or terminated, you do not have to take “no” for an answer. You can request a review of the decision or appeal the denial. It will likely be necessary to submit new information to support your claim, for example:

  • New medical records from your doctor and other medical professionals involved in your care and treatment.

  • A written statement from a medical professional explaining in detail the progression of your condition and/or exacerbation of your symptoms.

  • Written statements from your family, friends, and/or co-workers containing their observations of your medical condition and how it prevents you from working.

  • A written statement from you detailing remissions and relapses; explaining how you are able work some days but not others; and/or specifying the adaptations and accommodations in the workplace that used to permit you to work (e.g., modified duties, reduced hours, customized workstation), but that are no longer enough due to worsening of your symptoms.

  • Employment records, work performance evaluations, and/or letters from your employer that detail how your ability to work is negatively impacted by your illness or personal injury.

It’s important to note that internal review/appeal deadlines vary from policy to policy, but it is usually about 90 days. If you have had a change or exacerbation of symptoms and want to get your disability claim reviewed, act quickly. We recommend that you contact one of our Oshawa long term disability lawyers immediately if your LTD claim is denied or your LTD benefits are cut off. We can discuss your options and assist you with preparing a strong appeal.

We can also discuss another option: starting a lawsuit against the insurance company. If your condition has worsened or a period of remission has ended, and you have already provided the insurance company with all relevant medical records/evidence, an internal review or appeal may not be worth it. In these situations, a review or appeal is unlikely to change the insurance company’s own decision to deny your claim or cut off your benefit coverage.

Litigation may be in your best interests. The LTD policy will generally outline the limitation period to take legal action. Appeals do not postpone or extend the limitation period. If you miss the limitation period/ deadline, your legal claim is “statute barred” which means you can’t file a lawsuit and the insurance company doesn’t have to pay your long-term disability claim. If your long-term disability claim is denied you should contact our office immediately to ensure a limitation period is not missed.

Get advice from a long-term disability lawyer

Oshawa and Lindsay lawyers at Kelly Greenway Bruce know all the tricks and tactics insurance companies use. Once you hire Kelly Greenway Bruce, we deal with the insurance company on your behalf. No more struggling to figure out deadlines or dealing with insurance company gaslighting. You can focus on your health and taking care of yourself, knowing that you have a trustworthy advocate on your side. We encourage you to connect with our long term disability lawyers in Oshawa or Lindsay today.


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