You have options if your long-term disability claim has been denied, or your LTD provider has unexpectedly cut off your disability benefits. Insurance companies routinely reject legitimate LTD claims and employ shady tactics to avoid paying insurance benefits to people who need them the most. Don’t let those tactics get you down, and don’t give up!
Let’s talk about LTD appeal options and strategies to improve your odds of winning your appeal. For customized legal advice and guidance navigating the appeal process, we welcome you to reach out to our Oshawa and Lindsay law firm for a free case evaluation. Our long-term disability lawyers can help you prepare an effective appeal so you get the benefits you deserve.
Understanding Your LTD Appeal Options
If your disability claim is denied, you have two options. The first is the right to an internal appeal, which means asking the insurance company to reconsider its decision. The second option is the right to file a legal claim against the insurance company for wrongfully denying your LTD claim. A legal claim is an “external” appeal that is decided by a judge, not the insurance company.
It’s possible to use the internal appeal process first and then bring a lawsuit if the internal appeal is unsuccessful. However, caution must be exercised as insurers often use the internal appeal process to “run out the clock” on the two-year limitation period to commence a legal claim. Once the limitation period has passed, the insurer doesn’t have to pay your LTD claim, and you lose the right to sue the insurance company in court for disability benefits.
It’s strongly recommended that you consult with a long-term disability lawyer ASAP to discuss your legal rights, options, and the applicable deadlines for appealing or starting a lawsuit. Depending on your situation, the best strategy may be to skip the internal appeal process and move straight to starting a legal claim against the LTD disability insurer.
Strategies for Winning an LTD Appeal
You can greatly improve your chances of claim approval by taking a comprehensive approach to the appeals process. New information presented in a clear, cohesive manner will make it easier for the person reviewing your appeal package to reverse the decision and approve you for LTD benefits. Here are the steps our Oshawa, Lindsay, Whitby and Ajax long term disability lawyers recommend for preparing a winning appeal.
1. Be clear on the reason for the denial
LTD claims can be denied for many reasons, including missed deadlines, insufficient medical evidence, misinterpretation of the insurance policy, and failure to meet eligibility criteria (i.e., the insurance company says you aren’t “totally disabled”). The insurance company should send you a denial letter that sets out the specific reasons for the denial of your claim.
You must get very familiar with the reasons. Ask for more detailed reasons if the letter you get is vague. You may also need to request the insurance company’s complete claims file to see behind-the-scenes notes and reports. Once you know the specific reason(s) your claim was denied, you can focus your attack, gathering and submitting targeted evidence to refute each reason your claim was denied.
2. Provide notice of your intent to appeal, then gather evidence
The denial letter should identify the deadline for you to provide notice of your intent to appeal (e.g., within 30 days of the letter). It will also typically provide a second date by which you must submit new or supplemental information to support the appeal (e.g., within 60 or 90 days). These deadlines must be respected, and it takes time to collect the necessary documents and evidence, so you’ll need to act quickly.
The new and additional evidence you’ll need depends on the specific reasons your claim was denied. Commonly submitted on appeal are:
Past medical records not submitted with the initial application
New medical records and test results
New reports and assessments (e.g., specialist assessments, functional capacity assessments, vocational assessments)
A detailed supplemental report from your doctor that specifically comments on reasons for denial or gaps in your initial application
Written statements from witnesses such as family members, coworkers, and/or your employer
One of our experienced long term disability lawyers can help you identify and collect the documents and supporting evidence needed to boost the strength of your appeal.
3. Prepare a written summary and compile your appeal package
A clear and organized appeal package is much more persuasive. We typically recommend submitting a detailed written letter that summarizes your situation, provides a narrative of the progression of your disabling illness/injury and difficulties at work, and highlights the important medical documents and information.
It may also be advisable to submit a brief that presents arguments, critical evidence, and legal authorities supporting your appeal. The goal is to submit an appeal package that presents overwhelming evidence that makes it easy for the insurance company adjudicator to see why your claim should succeed. The other big benefit of getting organized from the outset is that you are better prepared for litigation if the insurance company maintains an unreasonable position.
Disability Claim Lawyers in Oshawa, Lindsay, Whitby and Ajax
Long term disability claim denials are like a slap in the face. The lawyers at Kelly Greenway Bruce know how stressful it can be to live with a disability. We want you to focus on your health and well-being, knowing you have a trustworthy advocate on your side.
Once you hire us, we will deal with the insurance company on your behalf. No more struggling to figure out deadlines or dealing with insurance company gaslighting. The dedicated long term disability lawyers at Kelly Greenway Bruce can help. Our team has extensive experience contesting benefits denials and will advocate on your behalf to get the compensation you deserve.
We encourage you to connect with the LTD disability lawyers at our Oshawa and Lindsay law firm today to request a free case evaluation.