When long term disability (“LTD”) insurance claims are denied, there is usually an option to appeal. Although most LTD lawyers advise against appeals, it may be a good option in some situations. Before considering an appeal, you should understand the appeal process, which may be summarized in ten steps:
1) Review denial letter – The LTD 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 whether it makes sense to 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 to 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. Long term disability lawyers can almost always find errors, mistakes, and sometimes evidence of bad faith. For the layperson, you will want to 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 may have referred 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 a second or third time. Instead, seek legal advice after a denied appeal.
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, including consulting a long term disability lawyer to discuss other options.
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.
Michael Jordan is a honest, fair and intelligent lawyer! He is very patient and spends as much time as is needed to ensure his clients understand what he is doing. I would highly recommend him! Sandra Clarke
Michael Jordan is a man you want on your side! He is compassionate, caring and beyond knowledgeable! He will never steer you wrong! Michael Jordan has already made a huge impact on our family and will always be our go to guy!
Michael Jordan was my lawyer for my long term disability case. I would recommend using him for a LTD case. He was very knowledgeable, helpful and always available when I had questions.
Review for Mr. Michael Jordan, Long Term Disability Lawyer. I am not usually a person who leaves reviews, but on this occasion I felt compelled to given the exceptional service I have received. I was in a situation where I required urgent guidance regarding an LTD matter, I decided that I would find someone who had a very high google review...
I contacted Michael for my long term disability claim. My LTD had been denied and so I reached out to him for help. The process from beginning to end was perfect and simple. He really is there for any questions or concerns and is so kind and helpful. He makes you feel less alone and cares about your well being. With his help I was able to get a...
Patient and kind, thorough and knowledgeable, that's Mr Jordan.Im grateful to have made a connection such as this! Thank you.
Michael Jordan is a Wonderful Caring Understanding Professional man that truly helped me when my LTD was denied several times as most are. I knew many people give up but I was entitled to LTD. I called Michael and sent all of my information with all of my medical and he said I had a case. He will take a percentage only if he wins which he did...
Many LTD lawyers will give you advice that will be biased to their advantage. Michael is the only lawyer I spoke to who wants what’s best for you, and does not care if he benefits from your decisions. His advice is fair, he is honest, and I would not trust anyone else with my case. He will tell you what is best for you. I appreciate him so...
Michael Jordan will personally return your calls. He listens to you and provides excellent advise. I strongly recommend him.
Michael was very pleasant to deal with. I'm pleased with the work he did for me, always replied and understood my issue and supplied useful information. I highly recommend him.
My experience with Michael Jordan was excellent. I was given much needed advice and everything was explained to me in very clear terms. Response time was outstanding! Michael was reassuring and compassionate and was able to resolve my disability claim very successfully. I would highly recommend Michael and his team to anyone.
Margherita Del Grosso
Mr. Jordan responded immediately to my first phone inquiry and has been readily available for detailed consultation and support throughout my long-term disability application. As the claim was finally approved and no litigation was required, there was no fee. Knowledgeable, professional and kind, there is no doubt that I will direct all my...
Michael Jordan is a wonderful lawyer. He is polite, very courteous and very professional. He answers his phone, responds to messages and takes the time to clearly explain the information that you need to know. He helped me out with an issue on little notice and was beyond helpful. If I could give him a higher rating than 5/5, I definitely...
I feel very fortunate to have come across Michael Jordan's practice. His responsiveness, sense of service, and professionalism inspired a lot of confidence in me to pursue my case. I highly recommend him to anyone who finds themselves in an overwhelming insurance process.
I recently had the pleasure doing business with Michael, he was very professional and did what he said he was going to do. Michael kept me updated through the entire process! I would highly recommend Michael's services and best of all I got the outcome I was expecting!
Very refreshing to have a lawyer actually pick up the phone himself. Gave me excellent advice free of charge regarding my LTD questions. Would highly recommend.
I would highly recommend Michael Jordan. From the very beginning, he was attentive, clear and precise with his direction, quick to respond and helped me through a very difficult time in my life. He assisted in making this process much smoother than I could have ever anticipated and I was very happy with the outcome. I would not hesitate for a...
Micheal Jordan is very knowledgeable and helpful in regards to long-term disability claims. Very willing to help by explaining and listening/understanding the problem. I would reccomend his services.
Thank you Michael, for your hard work. I like that if I needed anything your office was there to answer my question in a timely manner. You know your information and it was a great help on the case. Michael is respectful, hard work and knowledgeable gentleman that wants the best for he clients. Thank you Michael and Your team for your...
E. Anne Allan-Denys
LTD lawyer, Michael Jordan, jumped right on board to take my case, even though he did not have much time to prepare before the closing date of my case -due to my error. Also, Michael was right up front in our initial contact with his fees.
Due to the Covid-pandemic, we communicated through e-mails -including him taking correspondence...
Mr Jordan came into my disability fight with patience and kindness. He turned my situation around when I was being taken advantage of. He is very knowledgeable and knew exactly how to execute a plan to my benefit. He did exactly what he said he would do, and that is... Win! Thank you Michael Jordan. Much Appreciated!!
Great lawyer to represent you with legal matters. Michael answered the phone personally and listened to my initial concern. He then set up a meeting face to face (prior to COVID) and the rest was history. He is very professional and understanding. Michael was able to get me settlement and get the insurance company to pay.
I would strongly recommend Mike to represent you in a legal action. He is by far an excellent lawyer. Not only is he by far outstanding when it comes to the law but he knows how to handle your case from start to finish and win your case! He is the staple example of what a lawyer should be (has integrity, compassionate, honest, trustworthy,...
I strongly recommend Michael Jordan services as he displayed a high level of integrity. Michael proved to be responsive, knowledgeable, and professional with a high degree of emotional intelligence. My stress level was lessened with his attendance, support and knowledge of my case and situation. Retaining his services was the best thing I could...
Michael helped me with my STD and LTD case as my Insurance company denied all my applications from the beginning. His insight, dedication and professionalism has helped reach the agreement. I highly recommend him because whether it is your first time with a lawyer or not you will be treated like a known customer you will surely get help and...
Strongly recommend. Michael Jordan is professional, detailed and articulate. He can explain complicated issues and has the ability to translate them into a simple understandable terminology. My family was devastated when my LTD claim was denied. Michael defended my position and pursued the incident relentlessly. My very stressful situation...
Michael is one of the kindest and most caring lawyers. He was so patient with me and extremely attentive. Any time I had a question or concern, he would assure me that everything was going to be okay. During this difficult time as it is, he was able to continue with a mediation with ease and was able to have my case resolved to my utmost...
I was diagnosed with a chronic illness which made it impossible for me to do my daily responsibility of my workplace as well not including all my doctors and specialist appointments. I applied for my long-term disability that was provided by my workplace benefits. Unfortunately I was denied even with all the doctor's medical documents to...
When my family member was off of work and dealing with long term disability she went to Michael and was very pleased with his honesty, professionalism and candor. He worked hard and achieved a very positive result.
I am a lawyer and I have recommended Michael to many people because of the above-noted qualities.