If you’ve been diagnosed with a serious medical condition that prevents you from working, you may choose to file a claim for long-term disability benefits.
Many Sudbury residents experience severe illnesses or have sustained debilitating injuries that prevent them from returning to work for an extended period of time. In these cases, eligible individuals may turn to their insurance providers to collect benefits. But for a number of reasons, insurance companies may deny claims for long-term disability benefits.
If you believe your claim was unfairly denied, a Sudbury long-term disability lawyer may be able to provide you with assistance.
Get Help Before Filing a Long-Term Disability Claim
Generally speaking, individuals who are unable to work because of serious medical conditions cannot receive long-term disability benefits immediately following their diagnosis. In order to be eligible for long-term disability benefits, claimants must prove that, after several months of incapacitation, their medical condition will continue to prevent them from returning to work. During this time, the injured or ill individual may be eligible to receive short-term disability benefits.
Before submitting an application for long-term disability benefits, receiving both an official diagnosis from a medical professional and ongoing medical treatment for the disabling condition may help a claimant strengthen their application. Physicians and medical specialists may provide patients with evidence proving the severity of their conditions, which may be included in their applications for long-term disability benefits.
If your condition prevents you from thoroughly and accurately completing your application, a long-term disability claims lawyer serving the Sudbury area may be able to help you compile and assemble the evidence required.
What to Do if a Long-Term Disability Benefits Claim Is Denied
If your insurance company or the Canada Pension Plan (CPP) denied your claim for long-term disability benefits even though you believe you are entitled to them, a Sudbury disability lawyer may be able to help you.
Insurance claims may be denied for several different reasons. Since eligibility requirements vary between insurance companies, in certain cases, your medical condition may not be covered by your insurance company’s policy.
Insurance companies may also deny incomplete claims or claims where sufficient evidence was not provided. In these situations, a Sudbury long-term disability claims lawyer may be able to help you appeal the insurance company’s decision. Successfully appealing a denied claim may allow eligible claimants to begin collecting long-term disability benefits, even though their initial request was refused.
Filing an Internal Appeal for a Denied Long-Term Disability Benefits Claim
If your claim for long-term disability benefits is denied, you may have only a short amount of time to begin the appeal process. By contacting a lawyer immediately after receiving notice of a denied claim, you may be able to begin the appeals process within the limited period of time mandated by your insurance provider.
The notification letter denying your claim may include information about why your request for benefits was not approved. Using this information, a long-term disability claims lawyer may be able to compile appropriate evidence to file an internal appeal. This process may require you to resubmit your original claim along with additional supporting documents, such as:
- Medical testing results
- Documents from your healthcare provider
- Opinions from other medical professionals
By supplying missing information or resolving minor technicalities, an internal appeal may lead an insurance company to overturn its initial decision. However, in certain cases, further legal action may be required in order to appeal an unfair denial.
External Appeals for Denied Long-Term Disability Benefits Claims
In addition to filing an appeal internally through your insurance provider, a Sudbury long-term disability claims lawyer may be able to help you file an external appeal. External appeals are decided in the court system and may be necessary if your benefits claim was unfairly denied.
External appeals may lead to a tribunal hearing, in which a panel of experts may review your case along with an adjudicator to help reach a fair resolution. However, tribunal hearings may not be the best choice for your individual set of circumstances. Your Sudbury long-term disability claims lawyer may be able to provide you with useful advice about your legal options. Your lawyer may also recommend pursuing an external appeal through the court system.
In a court case regarding denied claims for long-term disability benefits, a judge and jury will determine a claimant’s eligibility to collect benefits, rather than the insurance company. If your appeal is successful, the court may require the insurance company to provide payment for:
- Long-term disability benefits
- Court costs or legal fees accrued
- Previously withheld benefits
- And possibly more
A court may also award successful claimants with punitive damages intended to discipline the insurance company if it broke any laws by denying your claim.
Contact Preszler Injury Lawyers Today
If you live in Northern Ontario and require assistance with your claim for long-term disability benefits, a Sudbury lawyer may be able to help complete your application or appeal an unfairly denied claim. Contact Preszler Injury Lawyers by calling 1-800-JUSTICE to discuss your legal options today.