Edge Benefits (BeniPlus) Long-Term Disability Claims

When dealing with long-term disability (LTD) challenges, understanding the claims process with insurers like Edge Benefits (operating as BeniPlus) is crucial, especially when your claim is potentially facing a denial. A LTD lawyer can help shed light on the unique aspects of your insurer’s policy, the nuances of your claim, and why a provider like BeniPlus might deny your claim.

Background:

Edge Benefits operates under the brand name BeniPlus and specializes in providing customizable and flexible benefits plans for small and medium-sized businesses in Canada. They offer a range of insurance products, including health and dental benefits, life insurance, disability insurance, and more.

Claims Process Overview:

Initiating an LTD claim with Edge Benefits/BeniPlus involves submitting detailed medical documentation, treatment records, and relevant information to support the disability claim. Familiarizing oneself with the specific requirements outlined in Edge Benefits/BeniPlus policies and effectively communicating during the claims process is paramount for claimants.

Can Edge Benefits (BeniPlus) Deny My LTD Claim?

Similar to other insurance providers, Edge Benefits/BeniPlus has the authority to deny LTD claims based on various factors such as inadequate medical evidence, policy exclusions, failure to meet disability definitions, or procedural errors in claims submission.

Why Do LTD Insurance Providers Deny Claims?

LTD insurance providers like Edge Benefits/BeniPlus may deny claims for many reasons, including:

Insufficient Medical Evidence:

One of the most common reasons for LTD claim denials is inadequate medical evidence supporting the claimant’s disability. Insurance providers require detailed medical records, diagnoses, treatment plans, and functional assessments to establish the extent of the disability and its impact on the claimant’s ability to work.

Failure to Meet Definition of Disability:

LTD policies often have specific definitions and criteria for what constitutes a disability under the policy. If the claimant’s medical condition does not meet the definition of “total disability” or “own occupation disability” as outlined in the policy, the claim may be denied.

Pre-existing Conditions:

Some LTD policies exclude coverage for pre-existing medical conditions or impose waiting periods before such conditions are covered. If the claimant’s disability is related to a pre-existing condition that falls under these exclusions, the claim may be denied.

Missed Deadlines or Documentation Errors:

Failing to submit claims within specified timelines, incomplete claim forms, or errors in documentation can lead to claim denials. It is crucial for claimants to adhere to all requirements and provide accurate and thorough information when filing an LTD claim.

Inconsistencies in Medical Records or Reports:

Discrepancies or inconsistencies in medical records, reports from healthcare providers, or opinions from different medical professionals can raise doubts about the validity of the claim, leading to denials.

Failure to Follow Treatment Plans:

Insurance providers may deny claims if the claimant fails to follow prescribed treatment plans or recommendations from healthcare providers without valid reasons. Non-compliance with treatment can be seen as an indication that the disability is not severe enough to prevent work.

Policy Exclusions or Limitations:

LTD policies may contain exclusions or limitations for certain conditions, treatments, or types of disabilities. If the claim falls under these exclusions or limitations, it may result in a denial of benefits.

Surveillance or Investigation Findings:

Insurance companies may conduct surveillance or investigations to verify the extent of disability claimed by the policyholder. Findings from such activities, if they contradict the claimant’s reported limitations or activities, can be used as grounds for denial.

Lack of Objective Medical Evidence:

Insurance providers often prioritize objective medical evidence such as diagnostic tests, imaging studies, and specialist opinions over subjective symptoms reported by the claimant. A lack of objective evidence supporting the disability can lead to denials.

What Does the LTD Claims Appeal Process Involve?

The appeals process for denied LTD claims with Edge Benefits/BeniPlus typically requires submitting a formal appeal letter, providing additional supporting evidence, and engaging in discussions with Edge Benefits/BeniPlus appeals representatives. Collaborating with legal professionals experienced in LTD appeals can significantly aid claimants during this phase.

Are There Time Limits for Filing Legal Insurance Claims in Canada?

Yes, specific time limits and deadlines exist for filing legal claims related to denied LTD benefits in Canada. Claimants must be aware of these timelines and take prompt action, including seeking legal advice if their claim faces denial challenges.

How Long Does the Claims Process Take?

The duration of the LTD claims process with Edge Benefits/BeniPlus varies based on factors such as case complexity, availability of medical evidence, and responsiveness of involved parties. Claimants should anticipate potential delays and diligently fulfill all requirements in a timely manner.

What To Do If My LTD Benefits Have Been Denied?

If facing denial of LTD benefits with Edge Benefits/BeniPlus, seeking legal counsel from a reputable personal injury law firm specializing in LTD claim denials is crucial. The disability lawyers at our firm can review denials, assess appeal grounds, gather pertinent evidence, and advocate for claimants during the appeals process or potential legal proceedings.

Contact a Disability Lawyer About Your LTD Denial Today:

Claimants encountering LTD claim denials with Edge Benefits/BeniPlus can greatly benefit from legal representation. Preszler Injury Lawyers’ team of disability lawyers are dedicated to advocating for your rights, negotiating with insurers, and pursuing the rightful disability benefits you deserve. Don’t hesitate to contact us for a consultation and take the first step towards securing your LTD benefits.