If you are receiving healthcare benefits from Great-West Life (GWL), through your employer, then you are able to file a long-term disability claim to receive paid leave and financial support for the time you are recovering from an illness or injury. Unfortunately, many employees are faced with rejected disability claims when seeking coverage in these difficult times. While some claims have been rejected due to incompletion or misfiling of the forms or required documents for a claim submission, in many cases employees face a denied claim which has been reviewed and denied in bad faith. Insurance companies ultimately do not want to shell out the required funds sought by employees when filing a disability insurance claim. It is in the insurance company’s interest to deny as many claims as possible, saving the company money and hours required for proper filing. Many insurance companies flat out deny claims, with no grounds for rejection, in hopes that a denied insurance claim will greet an employee who is already exhausted by the insurance process and will not pursue a process of appeal. You would be surprised how many times an insurance companies get away with wrongfully denying claims; unfortunately many who need the benefit are dealing with a lot on their plate and ultimately abandon the process in defeat.
It is important to understand that if your long-term disability claim has been denied, this does not mean that it has been rightfully or truthfully processed. Appealing a denied claim often grants you the benefits you are seeking. As an employee who is offered health-care benefits through Great-West Life, you harness the right to appeal a denied claim.
Steps to Appeal A Denied Great-West Life Claim
If you do not agree with Great-West Life’s decision to deny your disability insurance claim, there are several steps to appealing this decision. TSF Law highly suggest that if you believe your insurance claim / long-term disability claim has been denied due to bad faith, or for illegitimate reasons; if you are suffering from an injury or illness that makes it impossible for you to carry out your employment duties, contact us as soon as possible. By speaking with a lawyer who specializes in denied disability insurance claims, you will have a full understanding of your legal rights and may be eligible for our representation. In most cases, having legal representation during an insurance appeal quickens the process and grants one an approved claim with a possibility for further funds as a result of seeking damages. Since a personal injury lawyer work on a contingency fee basis, you do not have to pay your lawyer out of pocket.
Great-West Life has an appeal process that one must follow in order to appeal a denied disability insurance claim. If your long-term disability claim or short-term disability claim has been denied, and you wish to appeal the claim:
- Contact Great-West Life and explain in a letter (registered mail preferred), that you wish to appeal their decision. Upon receipt, GWL will respond with a list of possible additional information they may need in order to review your denied claim. At this time, we suggest that you contact your union or employer for further assistance. If your employer is not willing to work with you on this matter, we highly suggest you contact a disability claims lawyer as soon as possible. It is not advantageous to have an employer who may not be in support of your disability needs and is aiding in making the claim process more difficult.
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It is important that you make sure that all supportive medical documentation for you claim was submitted. Review your initial disability claim documents and make sure that what you have provided is sufficient enough to support your claim. If GWL has denied your disability benefits claim due to insufficient medical documentation, obtain any new medical information from your doctors/therapists/specialists, and send such to GWL as soon as possible. This added medical documentation will be used to re-assess your claim. You may be asked to see the insurance companies staff physician / medical adjustors at this time. We highly suggest you speak with a disability insurance attorney prior to meeting with an insurance’s staff physician. It is important that you understand that these doctors are hired to thoroughly scrutinize medical claims, for they are employed to save the insurance company money as well, thus support evidence to deny your claim.
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Make sure that GWL has received and reviewed an accurate description of your employment and employment duties. All vocational information is needed to reassess and review your denied claim. If any information is missing, send the needed documents as soon as possible.
After the following steps have been completed, by either you or a disability claims lawyer, Great-West Life will re-asses your claim and you will be notified if your claim has either been accepted or re-denied.
What to do if you receive a denied or terminated claim after the appeal process?
If you have already initiated the appeal process on your own, we highly suggest you speak with a disability insurance lawyer. Furthermore, if you are part of a union, we highly suggest you speak with your union about this matter and receive any provided assistance that you can. If you are already working with a lawyer, then they will choose whether to appeal this decision in the court of law, or through Great-West-Life’s Claim Review Committee (CRM), which is composed of doctors. The CRM process is as such:
- GWL will request that your long-term disability claim is to be reviewed by the CRM. They will also refer your claim to the Healthcare Benefit Trust’s (HBT) offices, whose staff will coordinate with the CRM for your claim.
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Your request for review will be confirmed through writing from the HBT office. The HBT will also forward you a package they have prepared containing all the claims forms, medical and vocation information provided in your initial claim, as well as copies of all correspondence. This package will also be sent to the CRM and your union (if you authorize such).
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The CRM will request a meeting with you, where you will be interviewed and possibly medically examined. At this point, you may be requested to undergo further medical tests after their examination.
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The CRM will decide, after their review, whether they agree or disagree with GWL’s decision to deny your long-term disability claim. A report will be written, with copies forwarded to you, your employer, your union, the HBT, as well as GWL.
If the CRM deems you as being disabled, under the applicable “definition of disability”, then your long-term disability claim will be accepted. If the CRM agrees with GWL that you are not disabled, your claim will be denied and your file will be closed.
Claims Review Committee Denies Appeal
If your long-term disability claim was denied after you have been reviewed by the CRM, you cannot appeal their decision on medical grounds. If you disagree “on a matter of interpretation”, you may appeal the CRM through the Labour Relations Board, after contacting your union representative. If you are not represented by a union, speak with a disability insurance lawyer to review your options.
Importance of Contacting a Lawyer
After reading this article, and understanding the claims process, appeal process, and the Claims Review Committee for Great-West Life, you should understand the importance of speaking with a long-term disability insurance lawyer as soon as possible, upon receipt of a denied long-term disability claim. The sooner you seek legal council and guidance in navigating a denied insurance claim, the more likely you are able to be approved for benefits. It is important that you spend your time and energy on healing/managing your illness or injury, and not on an insurance claim. The convoluted process of appealing a denied disability claim is extremely stressful and can even make your illness or injury worst. TSF Law is a high-esteemed law firm that specializes in denied insurance claims, specifically long-term disability. We offer free consultations and work on a contingency fee basis; call us today, TSF Law is always there for you.
