When your insurance company denies your disability claim or stops paying benefits after a period of time, it can feel like an impossible task to appeal their decision. Long term disability benefits are there to provide you with much needed financial support when a medical condition prevents you from working. Worrying about how to challenge your claim denial takes energy and effort which is hard to find when you are sick. It’s important to act quickly and get good advice by scheduling a free consultation with an experienced LTD lawyer to examine your options.

Understanding Your LTD Appeal Options

Some disability policies require you to submit an appeal before you can take legal action in the court system to challenge the insurance carrier’s decision. Your LTD lawyer should get a copy of your disability policy to determine if you have to appeal or if you can choose to access the legal system to challenge the denial.

Sometimes the best choice is to pursue legal action and skip the appeals process because the appeal will not be made to a neutral third party. Some insurers do have a process where the disability claim is referred to an appeals team as part of an internal appeal. However, most appeals are simply an offer to review further medical records in support of the long term disability claim. Put simply, you are simply asking for a reconsideration by the same decision-maker.

Steps for a Successful LTD Appeal

It’s important to understand that most LTD appeals are unsuccessful. Therefore, you will want to understand whether you need to go through the appeals process. If you take the steps set out below, you may obtain a positive result but if you don’t, please don’t give up – you need the financial support that disability insurance benefits are meant to provide. An experienced lawyer will be able to outline your options to challenge the insurance company’s decision.

Understand the Grounds for the Denial

The denial letter will set out the reason your benefits were terminated or denied and will usually advise you that you can submit an appeal within a specified time frame such as 30 days from the date of the letter. For instance, claims are denied for reasons such as insufficient medical evidence or when the definition of disability changes from own occupation to the harder to satisfy definition of any occupation.

If your case manager called to advise you that your LTD benefits were denied, make sure that you receive a denial letter so that you understand why your claim was denied. If your claim manager is confused about your medical treatment or has misinterpreted an update from your own doctor, it is possible that obtaining supporting documentation could overturn your denied LTD claim.

Provide Timely Notice of Your Intent to Appeal

Even if you aren’t sure whether you want to use the internal appeals process, you should advise the insurance provider that you disagree with their decision and will dispute the denial. It is important to act quickly but if you miss the insurance company’s appeal deadline, you are not out of luck. Many people with legitimate claims give up because while they know they are totally disabled, they know that all of the relevant medical documentation has already been submitted. It’s in your financial interest to get good advice from a disability insurance lawyer and to book a free consultation to review your case.

Gather Evidence

The denial letter will provide you with insight into the reasoning behind your long term disability claim being refused. For instance, the disability insurance provider may say that you have not been following medical advice or that there is no objective evidence that you are prevented from working. The disability case manager may not have received all of your medical records or they may have misunderstood information provided by your doctor. Therefore, you will want to provide your doctor with the denial letter in order to determine if further medical documentation could correct the error.

Prepare a Clear Summary of Your Symptoms and Restrictions

If you plan to appeal the long term disability claim denial, you should provide detail about your symptoms and how they prevent you from working. You will also want to summarize the ways that your illness impacts your activities of daily living and the ways that it prevents you from performing work tasks. If the definition of disability involves your own occupation, you will want to see whether the insurer has a good understanding of the essential duties of your job. It is a still a good idea to consult a disability lawyer before you submit your appeal as the lawyer will have insight about what to include and what is relevant to qualifying for benefits under a long term disability policy.

Do Not Miss the Limitation Period!

Every province and territory has a Limitations Act which provides a set amount of time to pursue legal action. The limitation period runs from the date of the denial letter. If the insurance company is considering an appeal, the limitation period is still running and is not paused by the appeals process. Therefore, even if you wish to appeal your denied long term disability benefits, you should meet with an LTD lawyer to discuss your case. If you have waited for a period before getting advice, your lawyer may determine that you need to start a lawsuit rather than going through the appeals process in order to make sure that you do not miss the limitation period.

Fear of Starting a Law Suit

It is natural to be afraid to start a law suit – particularly about something as personal and private as your mental and physical health. You may have never dealt with a lawyer in your life and be understandably concerned about how you could pay for legal fees given the fact that you have no income and your savings are dwindling.

We understand that you need to feel comfortable with your lawyer and the legal process. We will meet with you and explain the steps in the lawsuit. We explain what we will do to obtain a fair settlement or a positive award.

Seek Legal Assistance from a Disability Lawyer

Our experienced disability lawyers will meet with you in person, by phone or on Zoom to review the reason for your claim denial. We will  discuss the appeals process and your legal options. We have many years of experience disputing denials and terminations of LTD benefits and will provide you with detailed information of your legal options.

Please text 613-777-0992 or call us at 613-233-6898 to schedule a meeting with one of our lawyers.  We will provide a free consultation, in French or English, to ensure that your rights are protected.   In most cases, we can offer to represent you on a contingency fee basis.  This means that you do not pay legal fees unless you win or achieve a settlement on your case.