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When long term disability insurance claims are denied, there is usually an option to appeal. Although most LTD lawyers advise against appeals, it may be a worth considering in some situations. Before starting an appeal, you should understand the appeal process, which may be summarized in ten steps:
1) Review the denial letter – The disability insurer will provide you with a denial letter that briefly explains the reason for the denial and advise you of your right to appeal.
2) Consider whether an appeal is the best option – Most appeals are not successful. You do not have to appeal before taking legal action, which is a much more effective way of resolving disputes. You should seek legal advice to determine the pros and cons of an appeal.
3) Be aware of deadlines – The insurance company will give you a deadline to appeal. This time limit is usually arbitrary and should be extended with a reasonable explanation. However, the deadline for filing a lawsuit cannot be extended, even if an appeal is pending. In Ontario, the deadline for filing a lawsuit is two years from the date of denial.
4) Get a copy of the insurance company’s file – It is important you understand what the insurance company knows (and doesn’t know) before you appeal. There may be surveillance or other important points that you need to respond to if your appeal is going to have any chance of success.
5) Review the entire LTD file – The insurer’s file will likely be hundreds of pages, sometimes thousands, including extensive medical records, internal log notes, and correspondence. Long term disability lawyers can almost always find errors, mistakes, and sometimes evidence of bad faith. The layperson should be on the lookout for factual errors and signs that the insurer failed to fairly balance and weigh the evidence.
6) Obtain new medical records and other documents – The appeal will probably not be successful unless you are able to provide compelling new evidence of disability that the insurance company did not have at the time of denial. These new documents should include new medical records and reports from your treatment providers.
7) Write the appeal letter – Point out the problems you uncovered while reviewing the LTD file and highlight the new information you are providing for the appeal. Focus on your level of function, not just your diagnosis. Be truthful without exaggeration. Consider seeking legal assistance at this stage. Some LTD lawyers, including the author of this article, may be able to help with your appeal at no cost. You may also find this blog post helpful, How To Write A Long Term Disability Appeal Letter: Top 10 Tips
8) Wait for a decision – The insurance company will take approximately one to six months to process and decide your appeal, sometimes longer. It is possible that the LTD insurer will the new documentation you provided to an internal medical consultant, or it may require you to undergo an independent medical examination, which could further delay the appeal process.
9) If the appeal is approved – If the appeal is successful, past benefits owing will usually be paid and regular payments will begin or resume.
10) If the appeal is denied – Sometimes you have the option of a second or even third appeal. There is absolutely no reason to appeal again. Instead, seek legal advice after the first denied appeal.
In summary, the long term disability appeal process can be stressful and time consuming, and unfortunately, most appeals are not successful. You should therefore consider other options with a a long term disability lawyer.
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| About The Author Michael Jordan is a long term disability lawyer with more than 18 years experience litigating long term disability claims. He is a founding partner of the Bay Street firm Jordan Honickman Barristers, and is one of just 25 lawyers in all of Canada ranked by Lexpert as a “Leading Legal Practitioner” in long term disability law. Michael represents clients across all of Ontario, with satellite offices in Ottawa and London. Email: mjordan@jhbarristers.com Direct Cell: 416-460-6823 |
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