How to File an Insurance Claim for Chronic Pain Conditions

Posted on by Ben Tarnow Posted in Insurance Denials, Long-Term Disability, Chronic PainTagged , ,

Understand What Counts as “Chronic Pain” For Insurance

Insurers don’t approve benefits for medical conditions; they approve benefits for functional limitations. Chronic pain labels vary (chronic pain syndrome, fibromyalgia, complex regional pain syndrome/CRPS, neuropathic pain, post-surgical pain), but what matters is how your symptoms limit the essential duties of your job (own-occupation) or any suitable work (any-occupation) after the policy’s change-of-definition date. Your claim should connect credible medical evidence to real-world restrictions: lifting, standing, keyboarding, attendance, pace, and reliability.

People often think that merely confirming you have a medical condition can suffice when applying for insurance coverage and benefits, but that is simply not the case. You need to ensure you have the evidence to convince your insurance company that you are entitled to the insurance coverage and benefits you are applying for.

Pre-claim Prep: Build the Record of Your Chronic Pain Before You Press “Submit”

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What to Expect When Hiring an Insurance Lawyer for a Denied Insurance Claim

Posted on by David Goldberg Posted in Insurance DenialsTagged , ,

A denied insurance claim can feel like the floor dropping out from under you, right when you need help the most. Whether it’s a denied long-term disability (LTD) or short-term disability (STD) claim, a critical illness or life insurance payout that’s been refused, or a mortgage disability/accidental death & dismemberment (AD&D) claim stuck in limbo, an experienced insurance lawyer can change the trajectory of your case. Here’s what to expect from the moment you reach out for help to the point your claim resolves.

A focused intake and policy triage

Your first meeting should feel practical and reassuring. Expect your insurance lawyer to gather the essential information regarding your policy, the denial letter, claim forms, medical records, and a timeline of events. They’ll identify the type of claim (LTD/STD, life, critical illness, mortgage protection, AD&D, etc.) and spot immediate issues, such as notice requirements, proof-of-loss deadlines, and limitation … Continue reading

Understanding Long-Term Disability Buyouts

Posted on by Graham Taylor Posted in Insurance Denials, Long-Term Disability

The intent and purpose of long-term disability (benefits are to provide financial protection and income replacement to individuals who are unable to work for an extended period due to a disabling illness or injury. Unlike short-term disability or sick leave benefits, LTD benefits are designed to support individuals whose medical conditions prevent them from performing the essential duties of their occupation—or, in some cases, any occupation—for a prolonged duration. The overarching goal is to ensure that disabled individuals can maintain a basic standard of living and financial stability while focusing on recovery or long-term management of their condition by providing these individuals with a guaranteed monthly benefit to support them financially through a difficult time.

While long-term disability benefits are often, as the name implies, long-term, sometimes insurance companies will attempt to close an ongoing claim without denying a disability by offering an insured a buyout of their long-term disability … Continue reading

The Impact of B.C.’s New Sick-Note Ban on Short-Term and Long-Term Disability Claims

Posted on by Ben Tarnow Posted in Long-Term Disability, Short-Term DisabilityTagged , ,

British Columbia has moved to eliminate the routine doctor’s note for short-term sick leave. Under Bill 11, recent amendments to the Employment Standards Act [RSBC 1996] CHAPTER 113 clarify that employers cannot require a physician’s sick note for brief illnesses.

For lawyers handling short-term disability (STD) and long-term disability (LTD) claims, these changes raise important questions. How will the lack of mandatory sick notes for short absences affect the evidence supporting insurance claims? Will insurers adjust their documentation requirements? And how should litigation strategies adapt in light of this development?

Background: B.C. Bans Sick Notes for Short-Term Leave

B.C.’s new law represents a significant shift in employment standards. Prior to the change, employers could ask for “reasonably sufficient proof” of illness, which often meant a doctor’s note​.

Bill 11, introduced by Labour Minister Jennifer Whiteside in April 2025, amends the Employment Standards Act to prohibit employers from requesting a … Continue reading

Genetic Testing and Insurance Denials: What the Genetic Non-Discrimination Act Means for Canadians

Posted on by Brian Jacobson Posted in Insurance DenialsTagged ,

As genetic testing becomes increasingly accessible and integrated into modern healthcare, it has also raised complex legal and ethical questions, particularly in the realm of insurance. In Canada, the Genetic Non-Discrimination Act (GNDA), enacted in 2017, plays an important role in protecting individuals from being compelled to disclose genetic test results, especially in the context of employment and insurance relationships. But what exactly does the GNDA mean for insurance underwriting and the denial of insurance claims?

This interesting question came to our attention after reviewing an article posted by BRCAinBC, an organization that brings attention to and assists British Columbians affected by the BRCA gene mutations and associated hereditary cancer syndromes. Their article “What Can I Do If I Suspect Discrimination Due to a BRCA Gene Mutation” looks at potential discrimination due to an individual’s genetics, what implications that might have in the insurance realm, and potential remedies … Continue reading