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Most Common Reasons for Insurance Claim Denials

At our disability law firm, our primary focus is helping individuals who have had their insurance claim denied.

There are a variety of reasons why insurance companies deny claims for disability benefits. The vast majority of the insurance claim denials we review, however, typically fall within a few common categories. Outlined below are the most common reasons why your claim may have been denied, but it important to have a disability claim lawyer review your specific case to find out why your specific insurance claim was denied.

Most Common Reasons for Insurance Claim Denials:

Most disability claims are denied due to one of the following 3 reasons:

(1) insufficient medical support or “evidence”;

Your insurance company may claim that the medical evidence submitted does not “prove” your disability from work. This can be an extremely frustrating thing to hear after your family doctor or possibly treating specialist have confirmed that you are too sick to work. 

​Most of our clients suffer from either mental health disorders (such as Depression or Anxiety) or a form of Chronic Pain (such a fibromyalgia). Often, those suffering from one of these “invisible” diseases feel misunderstood. Because the health concern cannot be shown on a test like an X-Ray or an MRI, does not mean it is any less real or disabling. Nevertheless, your insurer may claim that there is a lack of evidence even after having confirmations from your doctors.

​(2) a claim that one does not mean the definition for “total disability”;

Total Disability is the eligibility criteria contained in most disability insurance policies in Canada for short and long term disability policies. A claim that you have not met the criteria for total disability is another way of saying that the insurance company denying your claim is insisting that you are able to work in accordance with the terms set out in your insurance policy. Speak to a disability rights lawyer to review your case and what you can do about a denial.

(3) work related stress or other similar non-medical triggers or aggravating factors.

Often disability insurance companies will look to other non-medical motivating factors that may cause an individual to remain out of work. The most common reason they will often point to are work-related issues like a problem with your manager, with co-workers, or workload issues. Unfortunately, most cases of severe anxiety, depression or pain disorders will usually be accompanied by (and often cause) workplace issues. If the reason you are unable to work is due to medical restrictions, you may still qualify for disability benefits regardless of workplace issues. Call one of our disability claim lawyers today to discuss your case.

How Free Insurance Claim Reviews Work:

Call us today to schedule a Free Disability Claim review.

We will arrange to have a Disability Claim Lawyer speak with you at no cost for a free case review. We will review the application, reasons for denial, and your options for either appealing the decision, or brining a claim, to ensure you understand your rights before making any decisions.​