Successfully Disputing A Denied Disability Claim

Jun 27, 2019 | Initial Consultation, Long Term Disability Claims

Moussa Sabzehghabaei

Personal Injury Lawyer

In 2012, Statistics Canada conducted a survey that revealed one in seven Canadians over the age of 15 suffer from a disability. It was observed that a high percentage of disabled Canadians are employed.  Only 49% of the disabled Canadians who participated in the survey were employed. This is much lower than the reported 79% employed non-disabled Canadians. From that survey, it’s clear that people living with a disability can have a challenge in making ends meet, mainly due to their inability to perform work and the stigma associated with disabilities.

Common Injuries in a Pedestrian Accident
Canadians are now purchasing disability insurance in a bid to protect themselves in the event of an accident that renders them unemployed for a prolonged period. The insurance policies are designed in such a way that they provide regular income to the insured when they are injured and unable to work after an accident.

Denial of Claims Based on One’s Credibility

All insurance companies are in business and they try to maximize their profits and to minimize pay-out of claims. One reason most insurance companies give for denying a claim is that the insured is faking or exaggerating their disability. This allegation is commonly regarded as ‘malingering’ and can be frustrating to the victim and their family. If one doesn’t seek proper legal representation, this claim can cause them to lose important benefits.

Unfortunately, there are some patients who malinger or exaggerate illness in order to receive external incentives such as avoid work or gain financial compensation. Malingering is difficult to prove. The court reviews evidence such as physicians’ opinion’s, medical test results, and most importantly, a claimant’s testimony and credibility. Even if a plaintiff is clearly not exaggerating their symptoms, an insurance company will try point to evidence to to undermine the plaintiff’s credibility and dissuade the court. Insurers may target gaps in treatment, unclear imaging or medical test results, medical reports prepared by insurer’s own experts and surveillance.

How to prove your claim

Insurance companies work with very experienced investigators who can gather evidence to conflict your claims of disability. Your insurance company may rely on an expert’s review of your medical condition, a psychiatric examination or even video evidence that conflicts your claim that you are disabled from working. You will need an experienced disability insurance lawyer who will build strong evidence against any charges brought against you before the court.

When involved in an accident that has resulted in a disability, there are some steps you must take.

1.       See a doctor

When an accident occurs, the worst mistake you can make is to ‘suffer in silence’. This will work against you for two reasons. For a start, you may not receive the treatment that you need to recover from a condition that may get worse over time. We’ve heard cases of accident victims who walk away from the scene only to be found in serious state later because they did not receive any treatment and simply assumed, they were fine.

There are certain medical conditions that are not obvious to third parties. For example, an individual who was involved in an accident can suffer a disability caused by pain that may become chronic in nature but cannot be objectively identified through any diagnostic imaging. It is common for insurance companies to attempt to undermine chronic pain as a basis for disability. Often times, a Court will need to be persuaded by reviewing the expert evidence from leading medical specialists such as vocational, functional, psychological and chronic pain experts.

2.       Document your condition in a journal

Keep a journal where you document your condition. This could be evidence that helps build a strong case and further proves your disability. Document important details such as the level of pain at different times of the day, your visits to the doctor or rehabilitation.

3.       Hire an experienced long-term disability lawyer

If you have been involved in an accident that has resulted in a disability that impacts your ability to work, speak to a lawyer who specialized in long-term disability cases. Disability law is complex, and you need the right expert to prove your claim. Your long-term disability lawyer will develop a strategy to refute all the efforts to deny your disability benefits and prove your claim.

3 reasons why you need a long-term disability lawyer

Disability lawyers work with the best medical experts to help diagnose the disability because they understand how critical this diagnosis is to your case. They will speak authoritatively using evidence from experts and refute the insurance company’s claims.

Disability lawyers take time to gather collateral evidence from all parties in order to prove that an individual’s behavior and daily activities have changed since the accident. They speak to people who are close to you such as your family members, colleagues and friends to gather all the evidence that will strengthen your case.

Experienced lawyers know how to respond to accusations made by disability insurers and gather the requisite evidence prove your claim.

Should you decide to settle outside court, an experienced lawyer will help you negotiate a fair settlement. Having a lawyer by your side will ensure that your rights are protected and that you are fully informed of your legal rights before you enter settlement negotiations.

If you have suffered a disability and your insurance company is denying your claim, speak to an experienced disability lawyer immediately. A lawyer will help you to understand your rights and secure a recovery you are entitled to.