Overcoming the Challenges of Disability Insurance Claims
Written by Michael Shepherd
Filing a disability insurance claim can be a daunting process, often complicated by the very policies meant to protect you. Many Albertans believe that simply having a policy guarantees financial support during times of need. However, the reality is that claim denials are surprisingly common. Insurers may deny claims for various reasons, ranging from incomplete applications to misinterpretations of medical evidence. Understanding these challenges is crucial to navigating the system and ensuring you receive the benefits you deserve.
One major hurdle in disability claims is the insurer’s reliance on incomplete or inaccurate information. Insurance companies base their decisions on documents submitted by the claimant, their physician, and their employer. A simple miscommunication or lack of detail in medical records can lead to a denial. For instance, phrases like "feeling better" in a doctor’s notes might be misinterpreted by insurers as an indication that the claimant is no longer disabled, even if they are still significantly impaired.
Another common challenge is the strict adherence to policy requirements. Disability insurance policies are detailed contracts that often include precise definitions and prerequisites for receiving benefits. Seemingly minor issues—such as a late application or failure to meet a specific policy requirement—can result in a denied claim. However, many of these denials are based on technicalities that can be addressed through proper documentation or legal intervention.
Policyholders also face difficulties when insurers apply broad interpretations of exclusion clauses. These clauses can exclude coverage for certain pre-existing conditions or circumstances, such as pregnancy or injuries sustained during acts of war. While these exclusions may seem clear-cut, they are often subject to interpretation. Courts have consistently ruled that such clauses must be applied narrowly, favoring the policyholder when ambiguity exists. This legal principle, known as contra proferentem, ensures that insurers do not unfairly benefit from the complexities of their own policy wording.
Despite these challenges, policyholders have options. Internal appeals and legal action can rectify many improper denials. Seeking advice from a lawyer who specializes in disability law is often the key to successfully navigating this process. Experienced legal counsel can help identify errors in the insurer’s reasoning, gather additional evidence, and present a compelling case for coverage.
Facing a denial of disability benefits can be overwhelming, but understanding the common challenges and knowing when to seek help can make all the difference. With the right support, many claimants find they are eligible for the benefits they were initially denied, allowing them to focus on recovery rather than financial uncertainty.
If you’re facing challenges with your disability insurance claim or have had a claim denied, our experienced lawyers are here to help. Contact us today to discuss your case and explore your options for securing the benefits you deserve.