Long-term disability insurance (LTD) providers must give policyholders the right to file at least one appeal if the company denies their claim for benefits. How many times a claimant may file this type of internal appeal to try to get a long-term disability denial overturned depends on the carrier’s process and the stipulations of the policy.
Filing multiple internal appeals may not be the most effective strategy to recover long-term disability compensation. It may even stall and hurt your case later. An external appeal, or lawsuit, may produce more direct results.
Downsides to the Internal Appeals Process
LTD insurance carriers are required to offer an internal appeals process so policyholders may challenge and attempt to overturn wrongful benefits denials. In theory, it should provide a simple way for people who qualify to have their case reconsidered. Unfortunately, these reconsiderations may not be an effective path to approval.
The appeals system that an insurance carrier provides is up to the carrier. Each insurance carrier defines how many times you may appeal the denial and what you need to do to request a reconsideration. Depending on the reason they denied your initial application, they may double down on their denial after your internal appeal.
When you file an internal appeal, it allows the insurer to build their court case, padding their file to show their due diligence in evaluating your qualifications. It also takes up a portion of the limited time you have to file an external appeal, or lawsuit.
In some cases, a disability lawyer may recommend you skip an internal appeal and go straight to an external appeal.
When an Internal Appeal May Be Effective
An internal appeal may be effective if the insurance company based the denial on a technicality, such as:
- A missed doctor’s appointment
- A missed medical treatment
- A clarification needed from a doctor
In these cases, you may be able to quickly address the technicality and file an internal appeal effectively.
The External Appeals Route
Even if you have new evidence to submit, a disability lawyer may determine that the external appeal is more strategic than an internal appeal. This determination may hinge on the precise reason the insurer gave for denying your initial application, and the overall strength of your case.
An external appeal means to sue the insurance company, and either negotiate a settlement with them directly or to fight them in court to have your benefits reinstated. If you prove you qualify for benefits, but the company denied your claim, you may be able to recover compensation in an external appeal.
A disability lawyer may be able to assist you in the appeal process by:
- Interpreting the exact reason for the denial.
- Preparing an internal appeal, if we believe it may be effective.
- Gathering additional evidence to support your appeal, if possible.
- Initiating an external appeal, filing a lawsuit, and negotiating with the insurance carrier on your behalf.
- Representing you in court if the insurance carrier does not offer a fair settlement.
A consultation call with a disability lawyer may clarify the next steps for you to take in your long-term disability denial case.
Time Is Limited to Appeal a Disability Denial
Time is vital in the long-term disability denial appeals process. The Limitations Act sets a strict two-year time limit on filing a lawsuit in these cases. In some situations, it may be necessary to file suit within one year of the denial. There may also be internal appeals deadlines set out by the insurer.
Contact a disability lawyer today to learn about the deadlines in your case and protect your legal right to appeal your denial.
Let Us Help You Fight Your Long-Term Disability Denial
If your long-term disability insurance carrier denied your claim for benefits, you may want to discuss your options with us before you decide to file an internal appeal. There may be a more strategic route for you to pursue compensation.
The team from Preszler Injury Lawyers serves all of Ontario. We can come to you if your medical condition prevents you from traveling to our offices.
Call Preszler Injury Lawyers now at 1-800-JUSTICE to learn more about our services. Initial consultations are free, and our firm works on a contingency-fee-basis, meaning there are no up-front costs for our representation.