By Nainesh Kotak
Having your long-term disability (LTD) claim wrongly denied or terminated can feel like a devastating blow, but challenging an insurer’s decision shouldn’t be overwhelming for injured workers.
At Kotak Law, we see an LTD denial challenge as a collaborative effort between lawyer and client. Working as a team, we break your matter down into simple steps and make the whole process less daunting.
Here are five simple steps that will set you on the road to success:
Step 1: Study the denial letter
As upsetting as it may be to receive, the letter denying or terminating your LTD coverage will be one of the most important documents in our fight to get you the benefits you deserve. The letter is critical because it sets out the reasons for the insurer’s decision to cut off your benefits and defines the terms for our response.
One of the most popular justifications insurers use to deny claims is “insufficient medical evidence” — a catch-all phrase to express their doubts that a worker’s lack of function can be linked to their disability.
In addition, we frequently see denials and terminations due to pre-existing conditions or surveillance reports that suggest a claimant may be exaggerating the effect of their injuries.
Another standard feature of the LTD termination letter is an invitation to participate in the insurer’s internal appeal process to challenge their decision. This is one part of the letter you can safely ignore since the whole procedure tends to be a waste of time. Like students grading their own homework, LTD providers rarely find fault with their original decisions and usually stick with their denials, leaving claimants in the same place they started weeks or even months down the line.
At Kotak Law, we see a lawsuit against the insurance company as a more effective solution, moving promptly to commence claims on behalf of clients and then progressing the case quickly towards a possible settlement.
Step 2: Gather medical evidence
Medical evidence is often decisive in a claim for LTD benefits, which is why one of your first priorities should be to gather medical records, assessments and reports on your conditions from all of your primary care providers, which may include a family physician, psychologist, physiotherapist, occupational therapist, or any other specialists who have been treating you.
Make sure to let your LTD insurer know any time you are referred to a new medical practitioner, prescribed a new course of treatment or undergo any therapies or procedures, such as surgery.
Step 3: Follow medical advice
Your lawyer is not the only person whose advice you should follow if you hope to succeed in your challenge to an LTD denial or termination.
Following a treatment plan recommended by their medical professionals is critically important for LTD claimants, and not only because of the help it provides in terms of symptom management and recovery.
It also demonstrates to the insurer that an injured person is doing all they can to get better and that they are meeting the terms of their LTD policy.
Updated medical records that reflect the results of a particular course of treatment could eventually convince your insurer to change their mind about your entitlement to benefits or support your legal case if they stick to their original decision.
Step 4: Obtain medical opinions
If the regular reports and assessments of your treating physicians are not enough to convince your insurer of your entitlement to LTD benefits, your lawyer may suggest seeking an additional opinion from a specialist with expertise in your specific impairments.
In addition to providing their opinion on an injured person’s diagnoses, treatment plans and prognosis, we also ask experts to address the claimant’s ability to function, with reference to the test they must meet to obtain LTD benefits.
Although individual policies differ, injured workers are generally required to show that they are totally disabled from performing the essential tasks of their “own occupation” to be entitled to benefits for the first two years of a claim. After that point, the test typically switches to a more stringent version, requiring an inability to obtain employment in “any occupation” for which they are currently qualified or could be trained.
Step 5: Obtain witness statements
Although they may not have the expert credentials to match the medical professionals involved, the friends and family of an injured person have much to offer in a legal case challenging an LTD denial.
At its heart, an LTD claim is about an injured person’s ability to function on a day-to-day basis. In some ways, there are no people better qualified to comment on that issue than their loved ones, who interact with them far more regularly than any physician or other treatment provider.
As the case gets closer to pre-trial, we encourage our clients to contact friends or family members who can speak to their injuries and provide some context about the effect their impairments have had on their daily life.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
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 or (416) 816-1500. Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario, 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, Fort Erie, Keswick, Kingston, Ottawa, Barrie, Timmins and other locations. We also serve clients throughout Alberta, including Calgary, Edmonton, Red Deer, Lethbridge, Medicine Hat, Fort McMurray, Grande Prairie, Airdrie, Spruce Grove, Lloydminster, St. Albert, Wetaskiwin, Camrose, Banff, Canmore, Jasper, Cochrane, Okotoks, High River, Sylvan Lake and others.