My disability claim has been denied. Now what?

To dispute a rejected disability claim, seeking medical advice and keeping detailed notes are just two of the steps you can take.

Nainesh Kotak 4 minute read January 14, 2022
For some when filing a claim, the constant phone calls and emails can be so stressful and triggering that their mental health declines even more. GETTY

For some when filing a claim, the constant phone calls and emails can be so stressful and triggering that their mental health declines even more. GETTY

Denials of disability claims have skyrocketed during the pandemic. In a sad irony of our COVID-19 times, pandemic-related delays in obtaining mental health care are the latest weapon in the arsenal of insurance companies fighting long-term disability claims.

For the one in five Canadians who suffer a mental illness, the pandemic has put additional stress on their ability to function at work, especially as public health restrictions continue. People suffering from depression have challenges that are hard to overcome and make work almost impossible. Medical treatment is often required, but what happens if their disability benefits are denied? Making ends meet and treating an illness become life-threatening issues.

What if you’ve filed a disability claim and it’s denied?

While it may seem self-serving, the heart-wrenching reality for many of our clients is that they turn to a disability lawyer after trying to fight a tortuous battle with an insurance company on their own. Often they share stories of case managers or insurance company contacts making them jump through hoops to supply more information to support their claim. For some, the constant phone calls and emails are so stressful and triggering that their mental health declines even more. In fact, battling an insurance company with vast resources can be a David versus Goliath endeavour for claimants who are often struggling to pay their bills and put food on their families’ tables — we recently worked with a client who couldn’t afford to pay for electricity and was keeping warm by burning wood in her fireplace.

Battling an atmosphere of uncertainty

There’s no question that the current atmosphere of uncertainty is creating a heightened sense of stress, anxiety and vulnerability among Canadians. Our office has had many calls from people who are essential workers, employed at liquor or grocery stores, who deal with random customers on a daily basis. Their risk of exposure to COVID is greater than the average person, and some have developed anxiety to the point where they can’t leave their homes. Many of them are paid minimum wage and never imagined that their job would place them in the eye of a global pandemic storm.

If you have filed a disability claim — whether because of long-COVID symptoms or mental health challenges — and it has been denied, there are steps you can take.

First and foremost, you need a medical practitioner in your corner. In most cases, that person is your family doctor. They can recognize the changes to your health and make the appropriate referrals to specialists. It’s essential to pursue medical attention to effectively manage and document your symptoms. Notes from your family doctor and specialists such as a psychologist, cardiologist or neurologist are helpful to prove that you sought medical help for symptoms or disabilities, and to dispute the common insurance rejection of claims due to “insufficient medical evidence.”

Keep notes

Secondly, document your symptoms and moods, because long COVID can change over time. You can also jot down the activities you can no longer do and how your ability to function has changed. Because long COVID can cause brain fog and memory issues, your notes will help you recall problems later.

Finally, take action before too much time has elapsed. If you can’t work and your claim is rejected, and there’s no money coming in, dragging out the fight against an insurance company may not be an option.

In my work as a disability lawyer, I find that companies often want to settle. Once a legal claim is filed, insurance companies have to consider the cost of fighting it and possibly losing in court. Often, settling is the best option for everyone — after all, insurance companies also have reputations to protect. Back to the David and Goliath analogy and any potential negative publicity, the public generally feels sympathy for the little guy, and rarely the large company.

Nainesh Kotak, is the founder of Kotak Personal Injury Law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. He also serves as the Chair of the Long-Term Disability Section of the Ontario Trial Lawyers’ Association.