4 reasons insurance providers might deny disability benefits

If you are seriously sick or hurt and cannot work because of your condition, you can file a claim seeking long-term disability benefits. While they cannot completely fix the situation, these benefits can help you support yourself and your family during a difficult time.

Because of this, it can be incredibly upsetting if your insurance provider denies your claim. They may do this for the following reasons:

  1. You missed a deadline: Depending on your policy and provider, there can be deadlines you must meet with regard to filing a long-term disability claim. If you miss a deadline, they could delay or completely deny your benefits.
  2. They deemed the claim invalid: Insurance companies will investigate a person’s claim, which could mean following you to take photos or videos. If the information they collect contradicts what you have said in your application, your benefits can be in jeopardy.
  3. They believed your condition does not prevent you from working: Insurance providers vary in their definitions of disability. And if they do not think you meet their definition, they may deny a claim. Thus, it is essential that you be honest and forthcoming with all the details of your condition.
  4. There was insufficient information: Applications that are missing medical documentation, personal information and other pertinent details may not be successful. Further, some policies require applicants to see an approved physician for an assessment. If you do not do this, the company can deny a claim.

If your insurance provider denies your application for these or any other reasons, do not lose hope. You can request a review and pursue an appeal if you disagree with an insurer’s decision.

It is crucial to understand your rights and options when it comes to pursuing long-term disability benefits. These financial remedies can be vital to your life and well-being when you are coping with a serious injury or illness.

Requesting workplace accommodations after disability leave

After being on short- or long-term disability, people returning to work can face obstacles they might not have experienced before their leave. One significant challenge can be returning to a job with conditions that make it difficult or impossible to participate in the workplace fully.

Under these circumstances, an employee can request accommodations that allow them to work. 

What makes an accommodation reasonable?

Under Ontario’s Human Rights Code, employers have a duty to provide accommodations that ensure employees with disabilities have equal access and benefits as other workers. However, one condition is that the accommodation must be appropriate. 

To be reasonable or appropriate, an accommodation must not be highly disruptive to other employees or fundamentally change the nature of the person’s job. Further, it must not put an undue hardship on an employer in the form of substantial expense or resources.

Some examples of an appropriate accommodation include:

  • Ergonomic equipment
  • Adjusted work schedule
  • Accessibility equipment
  • More frequent breaks
  • Additional support

These measures can enable a person to perform the essential functions of their job while preserving their dignity and allowing them to participate fully.

Requesting an accommodation

If you are returning to work and could benefit from an accommodation, you can submit your request to your employer. If you are unsure of what an accommodation might specifically look like, you might discuss the options with your supervisor. You can also consult your physicians or a lawyer to discuss possible solutions.

Keep in mind that any accommodation an employer provides should respect an individual’s dignity and promote integration.

It is also crucial to recognize that an accommodation that works for someone else may not be suitable for you. And your needs can change over time, meaning that you may need to make adjustments in the future.

Unfortunately, not every person will get the accommodations they need, either because an employer wrongfully denies them or the individual does not request them. Not only can this make it incredibly difficult to work, but it can also be a violation of a person’s rights.

Thus, if you are preparing to return to work after being on disability leave, assessing your needs and requesting appropriate accommodations should be high on your list of priorities to make the transition easier.

Burnout and long-term disability

Workers across Ontario are facing employment challenges that most would have never expected. And as stressful as the job market already is, it can be even more overwhelming to navigate if you suffer from a severe and long-term disability.

In some cases, extended periods of physical and mental anxiety due to work actually cause or contribute to serious health problems. This could be the situation for workers struggling with burnout.

What is burnout?

Workers in some occupations experience immense exhaustion due to high-stakes performance requirements, long hours or exposure to dangerous conditions.

Over time, this environment can take a devastating toll on a person’s mental and physical health. They can become cynical, careless and anxious.

Further, according to the Mayo Clinic, a person suffering from job-related burnout can have several different symptoms of this condition, including:

  • Depression
  • Difficulty sleeping
  • Fatigue
  • Irritability
  • High blood pressure
  • Increased risk of becoming sick
  • Heart disease

Without addressing the work or expectations causing the burnout, these and other serious symptoms can persist and become worse over time.

Is burnout disabling?

Although job burnout can affect workers in several severe ways, it likely would not be considered disabling in the context of disability benefits.

That said, it is possible for burnout to cause or contribute to conditions that do prevent a worker from performing his or her current job or a similar job. If this sounds like your situation, depending on your insurance, your condition could meet the definition of disability.

Seeking support for burnout

If you are experiencing mental or physical exhaustion due to your job, it is crucial that you seek support. Such support can include therapy, medical care, job accommodations or a new job altogether. These options can help you cope with stress and treat your symptoms.

Unfortunately, in some cases, burnout and the illnesses it exacerbates or causes makes it impossible for a person to continue working. And being unable to work and collect an income can only make things more stressful. In these situations, it can be critical to examine the options for pursuing disability benefits to help you through this difficult time.