If you have a medical condition that may not allow you to return to work, but a long-term disability (LTD) insurance carrier denied your claim for benefits, you may be able to challenge their decision. There are generally two ways this may be possible:
- Follow your insurance carrier’s process for filing an internal appeal.
- Take external action to dispute what you believe to be a wrongful denial of benefits, if you qualify.
Knowing which one of these options might be right for you may depend on the facts of your case. To help you decide if an internal appeal might be effective or just a waste of your time, it is recommended that you discuss your situation with a lawyer that may be able to analyze your denial letter and help you better understand the options that may apply to your case.
Internal Appeals Versus External Appeals
While a lawyer may advise their clients to pursue an external appeal and fight a seemingly wrongful denial, there may be some situations when an internal appeal may be successful. This generally includes cases when there was an oversight, inaccuracy, or missing document. These circumstances may arise a number of ways, including:
- If you missed a scheduled appointment that you later rescheduled and attended.
- If there was missing or unclear information in the documents submitted by your doctor.
- If you missed treatment but rescheduled and attended.
In situations when a denial may be based on a misunderstanding or a minor error, an internal appeal may be an effective option for policyholders, though there are no guarantees.
External appeals may allow you to have someone from outside of the company look at your case and determine if you may meet the eligibility as outlined in your policy, and therefore if you qualify to file this type of appeal. A lawyer may be able to help you navigate this process or take legal action against the insurance carrier if necessary, and if you qualify.
Working With a Lawyer may Help You Understand Your Case
A lawyer may be able to take steps that help you understand your LTD denial case, weigh your options, and possibly move forward with the appeals process if you qualify. These steps may include:
- Reviewing your claim and denial notice
- Analyzing the possible reasons behind your denial
- Explaining all deadlines that may apply based on your policy and Ontario law
- Offering an opinion on the possible outcomes of each type of appeal
Once you know whether you may qualify to file an internal and/or external appeal, a lawyer may be able to either help you follow the process outlined by your insurance carrier for filing an internal appeal or help handle your external appeal.
Pay Close Attention to the Deadlines in Your LTD Denial Appeal
The deadlines that apply to long-term disability appeals may play a role in whether you file an internal or an external appeal. Internal appeals may take time that you may not have, because they may not extend the deadline set by the Limitations Act of 2002, S.O. 2002, Chapter 24 on external appeals.
In general, those who qualify to file an external appeal may only have two years from the date on their denial notice to take legal action against the insurance carrier. This means you may lose the right to challenge the insurance carrier in court if you wait too long.
Talk to a Long-Term Disability Lawyer About Your Appeal
If you received a denial after filing a claim based on your LTD insurance policy, you may have options for challenging the denial and proving you have a qualifying medical condition that prevents you from working. At Preszler Injury Lawyers, our team serves workers with injuries or illnesses throughout Ontario, Canada.
Our team understands how LTD appeals work and may be able to help you navigate the process and seek compensation you may be entitled to, if you qualify. If you cannot travel to meet with us because of your medical condition, we may come to you at your home or another location.
Call Preszler Injury Lawyers at 1-800-JUSTICE to discuss your denial and your options for appeal with a member of our team. We offer free initial consultations.