Denied disability claims are unfortunately all too common, often resulting from minor mistakes such as errors on claim forms or missed deadlines. This can be a frustrating and disheartening experience since the reason we pay for long-term disability (LTD) policies in the first place is to gain peace of mind, knowing that we have a safety net in case of illness or injury. Unfortunately, long term disability insurance companies have a profit-first mindset, and sometimes they reject valid disability claims. This brings us to the purpose of this blog post–what should you do when your insurance denies your long-term disability claim?
We recommend these 3 things:
Understand the Reason for the Denial
The first step after your insurance denies your long-term disability claim is to understand the reason behind the decision. You can do this by carefully reviewing the denial letter and any accompanying documentation they provide.
Pay close attention to the specific grounds cited for the denial, whether related to a lack of medical evidence, policy exclusions, or procedural errors. Understanding the rationale behind the denial will enable you to address the issues effectively. That said, insurance companies may sometimes inform you of the denial over the phone. If this happens, request written documentation outlining the specific reasons for their decision.
Verbal communication can be easily misunderstood or forgotten, and having a written record of the denial is essential for several reasons. Firstly, it allows you to review the grounds for denial more carefully and understand the insurer’s perspective. This information will be invaluable as you proceed with the following steps. Secondly, a denial letter serves as official proof that your claim has been denied, which is necessary for filing an appeal or seeking legal assistance.
Gather Strong Supporting Evidence
Once you have identified the reasons for the denial, gather comprehensive and compelling evidence to support your claim. One of the key pieces of evidence is your physician statement, which your insurer typically requires during the initial application process. However, you can revisit this aspect and involve your treating doctor even after they turn down your claim.
Take your denial letter to your doctor and discuss the insurance company’s decision with them. If your physician disagrees with the insurance company’s decision, request that they provide a written explanation detailing their professional opinion. The statement should outline how your injury hinders your ability to resume work and serve as strong supporting evidence to substantiate your claim and challenge the denial.
In some cases, you may be receiving treatment from multiple medical professionals. If so, involve each relevant healthcare provider in the process. Let them provide you with written statements or letters commenting on your condition and supporting your LTD benefits claim. These additional opinions and perspectives can strengthen your case and provide a comprehensive understanding of your injury’s impact on your ability to work.
File a Legal Claim
In the denial letter, your insurance company will recommend an appeal if you are not content with their decision, usually within 30 days. But in our experience, appeals are meant to send you on a wild goose chase. The appeal is to the exact same company that already made a decision to refuse or terminate your benefits; not to an independent third party. All that typically happens is the clock starts ticking on your two year limitation period, while you go through the appeal process.
By filing a court action with a long term disability lawyer, you prompt the insurance company to face two options: provide you with the benefits you deserve or allocate significant resources to fight your claim. Mounting a strong defence comes at a considerable cost for insurance companies. Hiring defence lawyers and committing substantial financial resources to contest your claim can outweigh the potential savings of denying your LTD benefits. As a result, insurance companies frequently opt to pay legitimate LTD benefit claims through a lump sum settlement at or before Mediation, rather than engage in an extensive legal battle with a long term disability lawyer all the way through to trial.
Empower Your Claim: Let a Disability Lawyer Champion Your Rights!
If you face the denial of long-term disability benefits or encounter any concerning behaviours from your insurance company, take action. Reach out to a long term disability lawyer to increase your chances of winning the case.
They will assess the details of your claim, analyze the denial letter, gather compelling evidence, and build a strong legal strategy on your behalf. Not only that, long term disability lawyers understand the intricate workings of the insurance industry and are well-versed in disability laws and regulations.
At SG Lawyers, we are experts in disability laws and regulations and can provide you with the necessary guidance and support to navigate the complex process of appealing a denial. Don’t hesitate to reach out to us and take action to protect your rights and secure the benefits you deserve. Remember, time is of the essence, so act promptly to ensure the best possible outcome for your long-term disability claim.