Denied LTD benefits? Don’t opt for the insurer’s appeal, hire a lawyer

Denied LTD benefits

When workers are denied short- or long-term disability benefits by their insurance company, they can face an uphill battle getting the necessary evidence to argue their claim.

According to Statistics Canada, working-age Canadians have a one-in-three chance of developing a disability that will last for more than three months. Every day, we meet clients who have been off work because of a physical or mental ailment, but the insurance company says they don’t qualify for benefits. They’re struggling financially and doing their best to recover without much-needed support. After months of back and forth with their insurance company, many are so frustrated with the bureaucracy of the claim process, they give up.

Disability claims are often denied based on insufficient medical evidence, which means the insurance company isn’t satisfied that the applicant has provided adequate proof they cannot perform the tasks of their job. A doctor’s note stating you can’t work usually isn’t enough. We worked with a client recently whose doctor and four treating specialists supported the fact that she could not perform her job, but her claim was denied.

In an interview with Benefits Canada, Nainesh Kotak highlighted that more insurers deny claims based on what they perceive as insufficient medical evidence.

“Claimant’s physicians are often reluctant to fill out disability forms, and the brief conversations these doctors typically have with a disability insurance company’s staff nurses often leads to a mischaracterization of the doctor’s view of the claimant’s work-related restrictions,” he said.

Insurance companies often request an Independent Medical Examination (IME) conducted by a physician selected by the insurer, rather than the person’s doctor. The physician is meant to provide an unbiased opinion on the claimant’s illness, but that’s problematic given the IME is recommended and paid for by the insurance company, which does not owe a duty of care to the victim.

Internal appeal a protracted process

Suppose your claim is denied, and the insurance company invites you to dispute the decision through its internal appeal process — in that case, our experience shows it’s not worth the effort. These appeals can drag on for months or more as they progress through various levels. It’s rare for insurance companies to change their position.

There are two or three levels of appeal with many insurers, but there’s no set timeframe as to how long the process will take. If each appeal lasts three to six months, the claimant is potential without a source of income for more than a year. We recently worked with one client who couldn’t afford to pay for electricity and was kept warm by burning wood in her fireplace.

Throughout the appeal process, the insurance company often requests additional documentation to support the claim, placing more of a burden on fraught claimants who need to pay for the additional expenses. For example, suppose the insurer requests clinical notes and records by treating specialists for the last year — in that case, the claimant must cover the cost, which could be $500 or more. Frankly, even if it’s $10, that’s more than what many people can afford.

When you’re sick, you need to focus on your recovery, but instead, denied claimants spend their days on the phone with the insurance company and gathering documents from their doctors, social workers, psychologists or rehab professionals to prove they are, in fact, unable to work.

Burden on claimants

When faced with the prospect of disability leave from work of three months or longer, two-thirds of Canadians surveyed in an RBC study said it would have “serious financial implications” for them and their families.

While their benefit claims are in limbo, claimants struggle to pay their mortgage, rent and other living expenses. Their recovery is often stalled because they can’t afford to pay for medical or rehabilitation treatments out of pocket.

On top of that, the instructions claimants receive from the insurance company are often confusing and conflict with their doctor’s advice. We had a client suffering from anxiety and depression who was told by the insurance company if she didn’t participate in a particular program, her benefits would be cut off. Her doctor disagreed, advising that the program could make her condition worse. She followed her doctor’s advice and her claim was discontinued.

How a disability lawyer helps

Battling an insurance company with vast resources is a David versus Goliath endeavour for claimants who are often struggling to pay their bills and put food on their families’ tables.

As a law firm focusing on fighting for the rights of those whose disability claims have been denied or discontinued, we understand how to navigate the insurance companies’ red tape.

Hiring an experienced disability lawyer can be especially helpful when filing an appeal with your insurance company. A lawyer can help you avoid mistakes, ensure that the relevant forms and documentation are undertaken to help advance your appeal, assist with the judicial process involved in disability cases and help you negotiate a fair settlement.

It’s important to keep in mind that there’s a two-year limitation period associated with filing a lawsuit against your insurance company, and the clock starts ticking from the date your claim was denied.

Whether you need help with your appeal or filing a lawsuit, we take care of everything so clients can focus on their recovery. We gather all the records required to support your claim, draft letters to treatment practitioners and pay for the associated expenses. Our goal is to resolve the claim as quickly as possible so you get the closure you deserve.

If you decide to work with a disability lawyer to handle your claim, check our blog post for tips and key questions to ask a lawyer before hiring one.

We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.

Call your trusted long-term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario and Alberta, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Keswick, Kingston, Ottawa, Banff, Brooks, Calgary, Edmonton, Fort McMurray, Grande Prairie, Jasper, Lake Louise, Lethbridge, Medicine Hat, Red Deer, Saint Albert and other locations.