Chronic Pain and Disability Claim Denials

Living with chronic pain and disability is challenging and can affect every part of daily life. If you’re an employee dealing with such a condition, it can lead to additional stresses beyond physical issues, resulting in even more obstacles to navigate.

Whether you have difficulty accomplishing simple tasks or face barriers in the workplace, you might understand the uphill battle all too well. You know that encountering denials when seeking support through disability claims can feel like an added blow. 

This blog post will delve into the complexities of chronic pain and disability claims, common reasons for denials and how a Toronto disability lawyer can advocate for you. 

Understanding Chronic Pain and Disability

Chronic pain is defined as pain that lasts for more than three to six months and can range from mild to severe. It is caused by various conditions, including arthritis, fibromyalgia, nerve damage and back injuries amongst other physical and mental conditions. 

Chronic pain often leads to disability, limiting a person’s ability to work, perform daily activities and even maintain relationships.

What Is a Disability Claim?

A disability claim is a formal request for money or benefits when someone cannot work or perform daily activities because of a physical or mental issue. People usually submit these claims to insurance companies, government offices or employers to get financial help or support services when they cannot work due to their disability. 

If you experience chronic pain severe enough to potentially prevent you from working for 30 to 180 days or more, you may be eligible to apply for a short and eventually a long-term disability claim. It’s best to consult a Toronto disability lawyer to find out for sure.

Common Reasons for Denial of Chronic Pain and Disability Claims

Your chronic pain and disability claim might be denied on any of the following grounds:

1. Insufficient Medical Evidence: If the documents and records don’t clearly show how severe your chronic pain or disability is and how it affects your daily life, your claim may be denied.
2. Not Following Treatment Plans: If you don’t stick to the treatments your doctor recommended or follow therapy plans, the insurance company might think your condition could improve with proper care, leading to a denial.
3. Pre-existing Conditions: If your chronic pain or disability is connected to a health issue you had before getting the insurance, your claim could be denied. It depends on the rules of your insurance policy.
4. Not Enough Impact on Work: Some insurance policies require your chronic pain or disability to significantly affect your ability to do your job. If that isn’t proven convincingly, the claim might be denied. Your Toronto disability lawyer can ensure sufficient evidence is provided.
5. Missed Deadlines: Your chronic pain disability claim may be denied because it is outside the “qualifying period.” That means your condition hasn’t lasted long enough to meet the requirements for disability benefits.
6. Policy Exclusions: Your insurance policy may contain exclusions for specific conditions. It’s essential to carefully read and understand your policy to determine whether exclusions apply.
7. Improvement in Medical Condition: If the insurance company thinks your health has improved significantly, they might deny the claim, saying your disability no longer stops you from working.

Let a Toronto Disability Lawyer Help with Your Claim

Some insurers might reject your claim weeks or months after you submit it – or they might ask for more medical proof with impossibly short deadlines. To make matters worse, your employers might insist that you return to work or risk losing your job.

Fortunately, you can turn to a Toronto disability lawyer to get what’s rightfully yours.

At Lecker & Associates, our disability lawyers are experienced in employment law and have extensive medical knowledge of your condition. Moreover, we stand up against insurance companies in your best interests! Call 416.223.5391 or complete our contact form to book a free consultation with our Toronto disability lawyers.