Why do LTD claims get denied? (Part 1)

In our last post, we went over the basics of LTD insurance: what it is, how long it lasts, and what you can do if your application is denied or your benefits have run out. With today’s post, we’re kicking off a series on some of the most common reasons that insurance companies deny or cut off LTD benefits.

Missed deadlines

In the world of insurance, deadlines are critical.  In LTD case, those could be:

  • the requirement to apply for LTD within a certain number of days after your illness or injury
  • the requirement to appeal a decision within a certain number of days
  • the limitation period for filing a lawsuit as as result of a denied application (in general, the Ontario limitation period is two years, but this is often reduced to one year within the insurance policy)

Insurance companies will use every technicality available to reject your application, so it’s essential that you know and respect the relevant timeframes.

Not meeting the policy definition of “disability”

For better or for worse, there is no universally-accepted meaning of “disabled”. Every policy has its own definition, and your policy’s definition is the one you need to meet.

It’s also possible that your injury or illness is an “excluded” condition. Sometimes plans exclude conditions related to:

  • alcohol or drug use or abuse
  • self-inflicted harm
  • workplace injuries
  • criminal activity
  • known but undisclosed symptoms or pre-existing conditions

Are you dealing with one of these reasons for denial? Contact us for help, and stay tuned for our next post, where we’ll explain other common reasons for LTD denials.