Having your long-term disability (LTD) claim denied is a demoralizing experience, but it should never mark the end of your quest to get the benefits you deserve.
Many people are comfortable going it alone when applying for LTD benefits, and some may even enjoy some success navigating this tricky process. However, an insurer’s denial is often a good time to stop and consider whether you need a lawyer’s help before going further.
Here are my top three signs you may need legal help and what they could mean for your LTD claim.
SIGN 1: There were no administrative errors in your application
If there’s one thing I have learned during more than two decades in personal injury law, it’s that the list of reasons insurers use to deny LTD claims is never-ending.
Broadly speaking, these justifications fall into two categories: errors of administration and errors of substance.
If the only problems your insurer has identified are administrative — things like incomplete sections, unsigned documents, missing test results or other issues that can be easily fixed — there is no reason you can’t correct them yourself without the assistance of a lawyer.
However, challenges to the substance of your claim — such as how your injury affects your ability to work, the strength of your medical evidence, or whether your condition meets your policy’s definition of disability — are a clear sign to consult an LTD lawyer.
If you’re unsure about which category your denial falls into, an experienced disability lawyer can help you understand exactly what the insurer is looking for and how you should respond in a way that will maximize your chances of changing their mind.
SIGN 2: Your insurer directs you to their internal appeal process
An LTD denial letter will almost invariably inform claimants of their right to challenge the insurer’s decision. Many people wrongly assume this is an independent review process, but unfortunately, these internal appeal routes are generally ineffective.
There’s no neutrality in the process — and in some cases, your appeal may even be reviewed by the same adjuster who denied it the first time. Even in the best-case scenario, you will get another insurance company employee marking a colleague’s homework. Either way, the decision to deny is unlikely to change.
In my experience, litigation often puts more pressure on the insurer to take a hard look at your case and consider a potential settlement. However, it’s also important to remember that if you take your insurer to court over your LTD denial, Ontario’s Limitations Act generally requires any civil lawsuit to be filed within two years from the date the claim was discovered.
The clock keeps ticking on that two-year deadline throughout the insurer’s appeal process, so the longer it drags on, the greater the risk it will interfere with your ability to pursue a lawsuit.
The right approach will depend on the unique circumstances of your case, but consulting an experienced long term disability lawyer will give you the opportunity to fully consider litigation as an alternative to the insurer’s internal appeal process.
SIGN 3: Your medical evidence is lacking
One of the most common refrains for insurers denying LTD claims is the phrase: “insufficient medical evidence.”
But simply asking your family doctor for more detail about your injury is not always the answer. With some legal guidance, you can educate your treating practitioners on the precise terms of your insurance policy so they’re better equipped to frame their notes and reports in a way that clearly addresses the policy’s definition of disability.
An experienced LTD lawyer can also point claimants to occupational therapists, chiropractors, physical therapists and any other medical professional whose skills could be useful to their claim and their long-term health.
While our professional focus at Edwards Pollard is personal injury and disability law, we work closely with a trusted network of treatment providers and medical experts to help clients get the care they need while gathering the medical evidence required to support their claims.
If your claim for disability benefits has been denied or you’re looking for assistance to file an LTD application with the support of a long term disability lawyer in Oakville, feel free to contact me or another member of the team at Edwards Pollard.