Convincing your insurer to pay your long term disability benefits in accordance with its own policy can be very difficult. The insurance company may be determined to deny your application, delay the payment of your claim or pay less than what you are actually entitled to under the policy. Long term disability claims are usually expensive for insurance companies because the amount they are asked to pay can last for years. This is the source of the company’s motivation for short-changing you by selectively applying the language and scope of the policy.
How to React to a Denial of Long Term Disability Benefits
No one wishes or even expects to be disabled at some point in life. When you are suddenly disabled, you could get confused and the confusion could even increase if your disability benefits are denied leaving you hopeless. If your insurer denies your claim, it will cite reasons such as:
- You are not actually disabled
- You are not sufficiently disabled to be eligible for the benefits
- You misrepresented your medical condition at the time of taking out the insurance cover
It is good to have an idea of how to respond if you ever found yourself in a situation where your claim is denied. If it happens, you should never give up and move on to live a destitute life. Always have in mind the options available to you. You could prefer an internal appeal or litigation.
Appealing a Long Term Disability Benefits Denial
The denial letter will usually inform you of your right to appeal and the time within which you can lodge the appeal. The appeal is usually an internal process where you have your claim considered by a different panel and may involve up to three rounds. You can appeal denial of long term disability benefits or termination where you had initially obtained approval and have been receiving the benefits but the company stops paying you before the time stated in the insurance policy.
Understand your Denial Letter or Engage a Lawyer
Usually, your insurer will communicate the denial through a letter. If your denial is ever communicated through a phone call, which is very unlikely, you should insist on receiving written communication plus a copy of your claims file. The letter contains the reasons for the denial. It also informs you of your right to appeal and the timelines for filing such an appeal. Once you have received a denial letter, you should take the claim process more serious than ever. The best thing is to engage a long term disability lawyer to take over the process. However, if you are determined to pursue the benefits without the assistance of a lawyer, you should be ready to do more. You must read and understand the reasons given for the denial and compare with what the policy provides. This will determine whether it is worth appealing, or the insurance company is right. If the reason for denial relates to inadequate documentation, consider obtaining more evidence from your doctor.
Accept the Reality
While you have the option of filing your appeal by yourself, the reality remains that the insurance company has a whole legal department working to prolonged your application. Remember your insurer’s legal department always works to protect the interests of the company, for that is what they are employed to do. They will always take advantage of your unfamiliarity with legal concepts to diminish your chances of success. Hiring a lawyer ensures that you deal with the insurance company from the same level of knowledge increasing your chances of success significantly.
Some victims of long term disability have their benefits denied on a whim because they think they cannot afford to pay a lawyer. Most long term disability lawyers in Canada work on contingency basis which means that they will only deduct their agreed fees from the proceeds of the settlement they obtain for you.
Another reason to engage a disability lawyer is that you get advice on the best course of action after your initial application is denied. In Canada, there is no requirement to appeal internally before going to court. If your lawyer believes that going to court right away would be the best way to protect your interests, then you will not need to go through the internal appeals process.
Writing a Disability Appeal Letter
To write a good disability appeal letter, you must understand both the reasons given for denial and the insurance policy. This will help you know how best to phrase your appeal. If you decide to appeal the denial all by yourself, follow this link to find a sample disability appeal letter.
