Most common reasons for denial or termination of benefits


#1

The following are the most common reasons why LTD benefits are denied or
terminated:

insufficient medical evidence or absence of clinical signs and symptoms of a disabling
condition;

Inability of medical evidence to explain all of your disabling conditions and associated
limitations;

your condition has few objective findings and your capabilities do not correspond with
the medical evidence on file;

the extent of your medical limitations is not tied to your inability to work or other
vocational issues;

your physician does not support the condition as being disabling;

medical evidence is too subjective, too vague or is not supported by clinical evidence
(e.g. x-ray, laboratory results, diagnostic tests, functional capacity evaluation, mental
health status assessment results or depression status related score);

you may have a prolonged condition but have not seen a specialist to confirm your
diagnosis and ensure that you are on an appropriate treatment or rehabilitation plan.
This is especially important for conditions that may have a subjective component such
as pain conditions, fibromyalgia, and chronic fatigue as well as psychiatric conditions;

there in no ongoing treatment/rehabilitation plan;

your Employer has not adequately outlined the physical/cognitive/psychological
demands of your job in the ‘Employer’s Statement’ that they submitted to your Insurer

your physician has not responded to your Insurer’s requests or has not responded
clearly and completely;

you have provided insufficient information on the Employee Status Report or Activity Report sent to you
by your Insurer. In cases where your Insurer does not get a response they may
terminate the claim;

Your Insurer has sent you for an independent medical evaluation (IME) or a
functional capacity assessment (FCA) which does not support your disability; or
Your Insurer has not been provided sufficient information on your return to work
attempts or failed rehabilitation efforts.


#2

A similar list for getting denied CPP-D would be useful.