You’re suffering from a disability that is so severe, it prevents you from performing any substantive tasks at work. You’ve seen doctors, done tests, undergone assessments, and the doctors all agree about the severity of your disability. You did everything the insurance company asked you to do, provided them with all the paperwork they asked for and visited with their medical evaluator. You have a legitimate claim for long-term disability benefits and a need for financial support now that you are unable to work. And yet, despite all of that, your claim was denied.
The silver lining is that you can still get the benefits the insurance company tried to deny you, it’s just going to take a little longer than you anticipated.
Your first step is to contact a disability lawyer in Toronto as soon as possible. They will look at the insurance company’s reasons for the denial, and the application you submitted and immediately know what is needed to build a compelling enough case to get you the compensation you are entitled to.
Your Current Options
An Appeal Through the Insurance Company
In the denial letter, the insurance company likely advised you of your right to appeal their denial through their appeals department.
Most long-term disability lawyers strongly advise against this option.
The chances of a successful appeal are ridiculously low, and often their appeals process feels like a deliberate wasting of the time that you have to seek actual justice through the courts.
You have two years from the date on your denial letter to file a lawsuit against the insurance company. They know this, and their appeals process basically takes up that 2-year window. And it’s not just the length of time; during their appeals process, they routinely make the insured attend various assessments while they keep stalling and giving you the impression that they are seriously considering your appeal, and these assessments are necessary to help with their decision. And at the end of the day, most appeals are denied again.
Keep this in mind about insurance companies; they are in business to make money, which they aren’t doing when they pay out a claim. Also, the person who denied your claim and the person who denied your appeal both work for the same company and are paid by the same owner.
Two years to file a claim may seem like a long time, but your lawyer needs that time to build a strong case that relies on reports and opinions from medical experts. It takes time to get in to see them, and it takes time for them to create their reports. Keep in mind that attending these other medical appointments, assessments, and evaluations will have to be scheduled around your current appointments for the care you’re already receiving.
A Head’s Up
The insurance company may also send a letter to your employer, telling them that your claim for long-term benefits was denied. If your employer asks when you will be coming back to work, you can advise them that you are still disabled and are filing an appeal. If your employer isn’t satisfied with that answer, you can ask your doctor to issue you another doctor’s note excusing you from work. You must also speak to your long-term disability lawyer if your employer insists that you come to work.