Being diagnosed with fibromyalgia can change an individual’s life forever. For Canadians who can’t work due to this chronic condition, long-term disability (LTD) benefits can provide a vital financial lifeline.
Unfortunately, the path to securing these benefits is rarely smooth. In many cases, insurance companies deny legitimate LTD claims for fibromyalgia.
One excuse frequently used by insurers to prevent claimants from accessing disability benefits is that they don’t meet the definition of “totally disabled” under their policy.
READ MORE: 4 reasons why long-term disability claims are rejected
If your insurance company rejected your claim for LTD benefits based on fibromyalgia, here are three things you need to do.
1. Get your insurer’s reasons for the denial in writing
In our experience, it’s not uncommon for insurance companies to tell individuals over the phone that their LTD claim has been turned down.
By informing claimants verbally, this allows insurers to change their rationale at a later date if the decision is challenged.
If you were notified by phone that your LTD claim for fibromyalgia had been rejected, contact your insurance company and request a denial letter. This document will force them to “lock in” their reasons for denying you access to disability benefits.
READ MORE: Invisible illnesses: Can I still get long-term disability even if I don’t look sick?
As soon as you receive the denial letter from your insurer, connect with an experienced disability lawyer at Samfiru Tumarkin LLP. We can review your situation, assess your legal options and help you secure the compensation you deserve.
Even if you don’t have a denial letter, you should still reach out to our firm. We provide free consultations for issues involving LTD and can answer any questions that you have.
2. Discuss the denial with your treatment team
Once you have your insurance company’s reasons for turning down your LTD claim in writing, schedule a meeting with the doctor providing primary care for your fibromyalgia. It’s very important that the denial letter is brought to this appointment.
During the meeting, ask your physician if they agree with the insurer’s decision. In the event that they disagree, have them explain in writing why your condition prevents you from resuming your job duties.
The more supporting medical documentation you can provide, the better. If you are seeing other specialists or treatment providers, ask them to also weigh in on why you are unable to work.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
In some cases, insurance companies cut individuals off LTD benefits on or around the “change of definition” date. This usually occurs two years after a claim has been approved.
If this situation applies to you, it’s crucial that the medical professional providing primary care for your fibromyalgia clearly outlines in writing why it prevents you from doing any work – not just your own job.
3. Contact us
For many of our clients, having their legitimate LTD claim turned down was incredibly distressing. They weren’t sure how they were going to support themselves or loved ones financially without access to disability benefits.
If you are denied or cut off LTD for any reason, contact an experienced disability lawyer at Samfiru Tumarkin LLP. It’s very important that you get the right legal advice before appealing your insurer’s decision.
Our compassionate team regularly resolves issues involving LTD, short-term disability, life insurance, critical illness and mortgage insurance claims across Canada.
We provide consultations at no cost to you and don’t get paid unless we get results. Over the years, we have helped thousands of Canadians, including Sandra Bullock and Julie Austin, secure the compensation that they are legally entitled to.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
A troubling case that our firm recently handled involved a groundskeeper who was struggling with fibromyalgia.
Three weeks after applying for LTD benefits, he got a phone call from his insurance company – informing him that his claim had been rejected.
Devastated by the update, he asked his insurer why his application had been turned down. He was told that he didn’t meet the definition of “totally disabled” under their policy.
Resisting the urge to lash out at his insurance company, the groundskeeper requested a denial letter before hanging up.
While he waited for the document to arrive, he contacted Samfiru Tumarkin LLP for a free LTD consultation. We explained his rights and potential options, which helped him feel more confident about his case.
As soon as he received the denial letter from his insurer, he reached out to us again. After reviewing the document and the reports from the worker’s treatment team, it was clear that the insurance company didn’t do a comprehensive review of his file.
READ MORE: The insurer cut off his benefits. Then his lawyer reviewed his medical assessment
The groundskeeper’s treating doctors specifically noted in their assessments that his condition prevented him from doing any work – even on an hourly basis.
Following conversations with his insurer, we were able to secure an extremely favourable amount of compensation for our client.
Long-term disability claim denied? Asked if you want to appeal the insurance company’s decision?
Contact the firm or call 1-855-821-5900 for a free consultation with a disability lawyer. We help Canadians across all provinces (excluding Quebec). Get the advice you need and the compensation you deserve.
Sivan Tumarkin and Martin Willemse are disability lawyers at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in employment law and long-term disability claims. The firm provides legal insight on Canada’s only Disability Law Show on TV and radio.