Steps to Appeal Long Term Disability Insurance Denial

There is no such thing as being a 100 percent safe even if you are the most careful person in the world. This is why disability insurance is a mandatory coverage you need to get for work or personally. Every individual has chances of getting into an accident or contract an illness in his lifetime. This is what makes disability policies a good investment. But, making claims for these policies can be a complex struggle for most.
It has been reported that over half of health-related insurance claims were rejected in 2016 throughout Canada. This presents a major concern for many policy holders because medical cases are sure to require immediate attention. If you don’t have funds for hospitalization and therapy, the life will be more in danger. A long term disability denial is a grave situation someone who is chronically ill can be in. However, you can still get another chance to get your benefits. It might sound complicated to say you will file a case. But, it doesn’t have to if you are well informed. The following are information you will surely need about what to do as a victim of denial of long term disability.

Preparing for A Long Term Disability Denial Appeal

  • Obtain your official Claim File, Insurance Policy Document and Plan
    If your policy has been provided by your company,you should be provided with a complete copy of your claim file completely free of charge. Thus, before making it known that you are filing an appeal, request for a copy of the documents from your insurance provider. Also, make sure that they send them within a week or two.
    In order to make a convincing claim request, you need to have a lot of supporting medical evidence. You have to know what is already in your file so you can secure additional documents to support your claim. A long term disability insurance denial attorney can help you determine what type of documents to add and where to get them.

  • Obtain your Personnel File
    For disability insurance provided by the company, there might be complications when it comes to proving you are unable to work anymore. Secure your personnel file from your human resource officer to get an official job description of the signed contract with your employer. The description will be the basis for your proof to support the long term disability insurance appeal letter. Once you can firmly prove that you cannot perform the duties written in your employment contract, you will have a much stronger case.

It is good to note that all the request you make should be in writing. It will be an official part of the evidence, so it needs to clearly show who the people in correspondence are. The dates will also be a good basis for cross examination.

  • Write your Initial Appeal
    You have around 2 months to send a written appeal together with the supporting documents. A good appeal will contain your request, the medical evidence that refutes the claims of your insurance company and any other information that proves the denial is unreasonable. There may be a 45-day grace period for the administrator to respond to your request, with another 45 days extension if necessary. Be patient but keep yourself informed about anything related to appeal long term disability denials.

Know Your Rights to LTD Benefits

Not a lot of people know about long term disability benefits aside from it gives you money for medical bills when you get sick. Apart from knowing the coverage, you also need to know what rights you are entitled to as an LTD policy holder.
For instance, any individual can buy a policy personally from a private company. It is not a privilege that you can only get from your employer. If you want, you can have your own policy and pay for it independently.
When appealing long term disability termination, you might need additional documents. You have the right to access all medical information the company has of you throughout your subscription to their insurance. Even the Manulife LTD appeal process makes good use of medical documents. In relation to this, you can also choose which doctors to go to. It is not a decision by the insurance provider. You might need to have your choices approved, but you should still have the final say.
If your policy is provided by your employer, you have every right to make a claim. It cannot be a basis for a denied long term disability insurance. Even if the company is paying the premiums, the fact your name is listed as the beneficiary entitles you to the benefits.
Lastly, you have the right to appeal the company’s long term disability claim denial. It doesn’t mean that the company can simple deny your claim with a letter. You can question your decision and you can take it to court if they refuse to cooperate.