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The Long Term Disability Appeal: Worthwhile or a waste of your time?

We receive many calls every week from people who have been denied their Long Term Disability Benefits, by private disability insurers such as Great West Life, SunLife, Manulife, Standard Life, Industrial Alliance, SSQ, Co-Operators, Empire Life, RBC Insurance and others.

People want to know what to do after they’ve been denied.

Denial, or termination letters are often lengthy detailed letters which include the provisions of your LTD policy, the definition of the term “disability” based on the policy, excepts from medical records or medical reports, along with the insurer’s reasoning to deny or terminate benefits.

After these long winded reasons are provided, the insurer will also then include ways that you can appeal their decision. Statements like you have 90 days from the date of this letter to appeal this decision through our Appeals/Investigation Committee are common. People call our law firm in an absolute PANIC stating that they’re under the gun and that their opportunity to appeal the claim is fast approaching.

What I tell these people is NOT TO WORRY, and NOT TO PANIC. These internal reviews or internal appeals are often a waste of time and energy. Here’s why
I should preface this Toronto Injury Lawyer Blog Post by stating that the information below relates to private long term disability claims. It does NOT relate to claims for CPP Disability Benefits. Dealing with CPP Disability is a unique animal unto itself and their appeal process has its own unique twists and turns. When CPP Disability tells you that you have 90 days to appeal their decision, you better listen to them.

In my eleven years of practicing law on behalf of injured parties and disability claimants, I have NEVER seen a denial, turned in to an approval following the appeal/internal review process.

The whole process is there, in my humble opinion, to give you the policy holder along with the rest of the world, the optics that your claim is being handled in good faith and that they are willing to consider additional information/documentation with respect to your claim.

Long Term Disabilty Insurers have an obligiation to handle your claim in the utmost good faith. That means something at law. Part of this good faith agreement is having an appeals process. Does that mean that your claim will get approved on appeal or internal review? There is a very strong chance that it won’t mean a thing.

All it means is that a new set of eyes within the company will examine your claim. The second denial will essentially pad the insurers file, providing additional justication for the denial.

Adjuster “A” denied the claim. So, we sent the claim to Adjuster “B” in our internal review department to give it a fresh look. And guess what. Adjuster “B” agreed with Adjuster “A”‘s findings! Go figure! The insurance company has just found further reason to justify the denial of your claim.preview-200x140.jpg

In my experience, these appeals serve as nothing but a public relations tactic and legal tactic for insurers to give off the impression that they’re properly handing your claim. Nothing more.

The time limitat which insurers put on claimants to make an appeal is relatively meaningless. At the end of the day, your case will come down to the wording of the LTD policy, and your medical condition.

The ultimate limitation period will be 2 years from the date of the denial or refusal to pay your benefits. Wait longer than 2 years after the denial and your case will likely be dismissed for missing out on a limiation period, and nobody wants to see that happen.

So does this mean I shouldn’t bother with the appeal process? That all depends on the type of person you are. Those who doe these appeals themselves are often playing lawyer without any legal training. Would you want somebody with no medical training to conduct a brain surgery, or would you rather a brain surgeon?

If you’re really serious about your claim, you’ll call a personal injury lawyer to get you the results you deserve instead of waiting around for a second rejection letter from the insurance company. You’re risking hurting your case without even knowing you’re causing damage. This is a game I wouldn’t recommend to anyone.

Speaking of games: I’ve seen a case when a person who didn’t know about the two year limiation period waited for her appeal decision to come in the mail. She NEVER got the letter. So she waited and waited without calling a lawyer. The letter got lost in the mail and never arrived. She put her long term disability claim in jeopardy by waiting so long for the appeal decision. In the end, we were able to advance her claim within the two year limiation period, BUT, she was very close at risking the life of her claim on account of waiting for that appeal decision letter. When the appeal decision letter finally arrived, guess what? It still didn’t approve her long term disability claim.

The best results we’ve seen at our office is when we start an action (sue them). Litigation is a sure fire way of getting a big insurance company’s attention. Who can blame them. Nobody, even large insurance companies like to be sued.

I hope that answered some of your queries when it comes to independent reviews or appeals by Long Term Disability Insurers.

Now, on to better things. Congrats to Team Canada for their rocket fire start at the Sochi 2014 Winter Olympics. They’re doing spectacularly well! One of my favourite Twitter Feeds as been from @SochiProblems. It basically shows some of the poor conditions met by athletes and media when they arrived at the games. The $50 Billion Dollar price tag for these games is incomprehensible. That’s the annual GDP for many countries, just for a large scale sporting event! So far I’ve been enjoying the games and wish Team Canada the best of luck and success competing against the world’s best. I don’t think that Southern Ontario will ever get the Winter Games because we don’t have elite calibre ski hills for the alpine events. Sorry Collingwood Blue Mountain. Those skiiers need monstrous mountains in order to compete.

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