Denied for Disability Insurance in BC? Know Your Rights
Was your long-term disability claim denied by insurance? Unfortunately, claim denials are common in British Columbia, even for people with legitimate medical conditions. It’s important to know that a denial by the insurance company is not the end, you can still fight for what you deserve.
We’ll explain what long-term disability insurance is, why claims are often denied, and the steps you can take to fight back.
This article contains general information and is not legal advice. For qualified legal advice, please call 604-876-7000 to get in touch with a BC Disability Insurance Lawyer near you.
*Please note that if you are a union employee and are subject to a collective agreement that references a disability insurance plan, you should immediately discuss your claim with your union representative. Our firm may not be able to assist in these situations. Limitation periods can be very short—sometimes weeks—when a union grievance process is available.
When a Disability Insurance Claim is Denied
No matter what medical evidence you have, it’s up to the insurance company to determine whether your condition is severe enough for benefits. Unfortunately, insurance companies are well known to deny claims mistakenly or in bad faith. In fact, insurance companies deny most long-term disability claims.
When a claim is denied, the insurance company is obligated to give specific reasoning as to why. You have the right to know why your claim was denied.
The Disability Insurance Company Isn't Always Right
Something we tell all our clients is that the insurance company is not always right.
Paying out a long-term disability insurance claim is incredibly costly, and insurance companies know that. They benefit significantly more when claims are denied vs. when they are paid out. Insurance companies will often avoid paying out if they can, leading to wrongful denials.
Furthermore, insurance companies will frequently use subtle language that implies your claim is not strong enough and dissuade you from appealing or suing. Let’s walk through some of the most common reasons for denying a disability in bad faith, and how claimants are often dissuaded.
Common Reasons for Denial: Understanding Your Rights
Reason 1: Lack of Adequate Medical Evidence Showing You Can’t Work
Insurers often reject claims when the disability isn’t obvious, such as with mental health issues like depression or anxiety, or conditions like chronic pain. However, mental disabilities/illnesses are still eligible for long-term disability insurance coverage, so don’t be deterred. As long as you can prove it is disrupting your ability to work, this reasoning should not make you give up your claim.
If you were denied long-term disability insurance because of a mental illness, please contact us for legal advice!
Reason 2: You Are Not “Totally Disabled”
The phrase “totally disabled” might make you assume you need to be incapacitated and unable to care for yourself for coverage. This is not the case. Your disability doesn’t need to be that severe to make a long-term disability claim.
What you actually have to prove is that you cannot do any type of job (not just your current job), to be classified as “totally disabled”. This is tough to prove, but working with a lawyer who specializes in long-term disability claims can help. We can assist you in demonstrating that your disability has rendered you unable to work.
Book a no-obligation consultation or call us at 604-876-7000 for legal advice!
Reason 3: Disagreement Between Your Doctor and the Insurance Company
Even if a doctor has provided extensive medical evidence for your disability, insurance companies can still deny you because they disagree with your doctor’s assessment.
Insurance companies usually have their own doctors review claims. It is common for these medical examiners to not agree with your healthcare provider’s assessment. Luckily, this doesn’t mean your claim is automatically invalid.
Their doctor’s evidence is often not as extensive as what your own doctor can provide. This disagreement alone shouldn’t deter you from pursuing your claim in court.
Get legal advice from a British Columbia disability insurance lawyer!
Reason 4: Surveillance “Proves” You Are Not Disabled.
In British Columbia, insurers may hire investigators to monitor claimants if they suspect exaggeration or fraud. This can include taking photos or videos of you in public, as well as monitoring your social media posts.
Don’t be deterred, surveillance is a common tactic insurers use, and it usually doesn’t provide enough proof to discredit your claim. Many disabilities are not visible, so surveillance cannot disprove much, especially if you have an “invisible disability“.
Your Rights After a Disability Insurance Claim Denial
If your long-term disability claim is denied, you have the right to appeal it internally or file a lawsuit. It’s important to understand your rights and the steps you can take to challenge the insurance company’s decision.
Option 1: Appeal the Insurance Company’s Decision Internally
You have the right to request an internal appeal after your claim is denied. However, it’s important to understand how this process works. The same insurance company that denied your claim will be the one reviewing your appeal. Essentially, you’re asking them to overturn their own decision—which rarely happens.
While it’s still worthwhile to submit an internal appeal in some cases, the window to file a lawsuit is small. Insurance companies are often reluctant to reverse their original decisions, so be prepared to take legal action as soon as you can.
Option 2: File a Lawsuit Against the Insurance Company
You also have the right to sue the insurance company. You have two years from the date of the denial to file a lawsuit. Filing internal appeals does not extend this two-year limitation period.
Although you technically have two years, it’s recommended that you take legal action within the first year to avoid missing important deadlines.
Be aware that insurance companies may try to discourage you from pursuing legal action. You may be told that you must submit an internal appeal within three weeks or lose your right to appeal. This is not true. You always retain the right to take your claim to court.
Why File a Lawsuit for a Denied Long-term Disability Claim
When appeals are made internally, the insurance company stays in control, but filing a lawsuit forces them to take action.
They must defend their decision and provide evidence that their denial was justified. If the denial was made in bad faith or without proper reasoning, you may be able to get justice.
We’ll help you fight for the income protection you are entitled to — reach out to a British Columbia disability lawyer for legal advice on your situation.