Why do disputes arise between employees on long-term disability and insurers?

The last thing that an employee on long-term disability (“LTD”) wants to deal with is a dispute with the insurer. Unfortunately, these disputes arise all too often. Recent leaks of internal documents and statements by former employees has revealed that not all claimants may be given a fair chance with their claims. If your Cigna Long-term Disability Claim is denied in Ontario, there are options available to you. Cigna cannot deny claims if you are legitimately disabled and unable to work. It is therefore critical that you put your best foot forward in evidencing your case and dealing with any appeals.

What are the potential reasons for a Cigna Long-term Disability claim denial?

Cigna, and other insurers, have a long list of reasons for why a LTD claim may be denied, including:

• Failing to meet the definition of ‘totally disabled’
• Disagreement with your doctor’s diagnosis
• Insufficient medical evidence
• Possibility of working in a different occupation
• Evidence suggesting that you can work
• Relevant pre-existing conditions

If your LTD claim has been denied, it is important for you to know that you have options, and that you should speak with experienced counsel to ensure that your claim is handled properly. Just because Cigna has denied your claim does not mean that its decision should stand. Be sure not to panic, there are steps that you can take to protect your interests and pursue your claim further.

How can you ensure your claim is handled properly after denial?

As a first step, you should ensure that you receive Cigna’s written decision. This is important, because it should detail the exact issues with your claim and reasons that it was denied. You should then work with your doctor to ensure that you have all of the relevant medical data supporting your disability. At this point, you should also engage counsel that specializes in long-term disability claims.

Unfortunately, insurance companies deny many claims, and often require an appeal to get them to pay out your entitlements. The appeal is a review process conducted internally by the insurance company.  Another option is to pursue an independent claim with an LTD lawyer. If you do not feel that your claim is being handled properly, there may be options outside of the appeal.

How can Whitten & Lublin assist with employment-related matters?

To better understand your disability insurance rights and explore the viability of a claim, we encourage employees to seek legal advice. Equally, we encourage employers to speak with a lawyer to understand their rights and obligations, or any other employment concerns. We at Whitten & Lublin are happy to provide insight and advice into your specific circumstances. If you are looking for employment lawyers and would like more information about what Whitten & Lublin can do for you, please contact us online or by phone at (416) 640-2667 today.

Author – Rachel Patten