Individuals in Ontario who are unable to work due to a medical condition are covered by disability insurance. However, petitions for disability payments are occasionally refused for a variety of reasons. In this post, we will look at the most prevalent causes for disability rejection in Ontario, as well as what may be done in these situations.
Lack of Medical Evidence
A lack of medical proof to support the claim is one of the most prevalent reasons for disability denial in Ontario. To verify the severity of the medical condition and its influence on the individual’s ability to work, insurance companies frequently request a complete medical history and medical documents. If the necessary medical proof is not given, the claim will most likely be refused.
Safeguard your rights and your future. Use the services of our knowledgeable long-term disability lawyers to reduce the probability of claim denial. Use our knowledge and experience to help you win your case.
A pre-existing medical condition is another cause for disability denial in Ontario. If the individual had a medical problem before the disability coverage began, the insurance company may refuse the claim. The individual may be required to demonstrate that the current handicap is unrelated to the pre-existing ailment.
Failure to Follow Treatment Plan
Insurance companies may also deny a claim if the individual does not adhere to the prescribed treatment plan. This might include neglecting to keep medical visits, failing to take prescribed drugs, or failing to follow medical advice. The insurance company may argue that if the individual had followed the treatment plan, their medical condition would have improved.
Exclusions in the Policy
Exclusions in the policy are another prevalent basis for disability rejection in Ontario. Certain medical illnesses or types of disability may be excluded from the coverage. For example, the policy may not cover disability caused by self-inflicted injuries or criminal activity. Before filing a claim, it is critical to study the policy’s exclusions.
Inadequate Information in the Application
If the individual fails to supply all of the required information in the application, the disability claim may be refused. A lack of medical history or inability to provide comprehensive and accurate information about their medical status might be examples of this. To avoid a claim being refused, it is critical to give comprehensive and precise information in the application.
Exceeding the Maximum Benefit Period
Disability claims may be dismissed in specific situations if the claimant has exceeded the maximum benefit duration. The maximum benefit term is the longest period during which benefits can be provided. The insurance company may stop paying benefits once the maximum benefit term has been reached.
In Ontario, if a disability claim is refused, the individual has the opportunity to appeal the judgment. The appeals procedure normally include an impartial panel reviewing the matter. Additionally, the individual may be able to submit additional medical proof or information to back up their claim. If the appeal is successful, the insurance company may be forced to pay back benefits.
In Ontario, disability rejection may be a stressful and perplexing affair. However, it is critical to comprehend the most typical reasons for disability denial as well as the appeals procedure. Individuals can improve their chances of getting benefits by giving complete and correct information, following the prescribed treatment plan, and appealing the decision if required.