What are the common reasons for RBC denying long-term disability claims in Ontario?
One common reason for RBC denying long-term disability claims in Ontario is insufficient medical evidence. Insurance companies require substantial documentation from healthcare providers to validate the severity and duration of the disability. If the medical records, test results, or physician statements are deemed inadequate or inconclusive, RBC may deny the claim.
Another frequent reason for denial is the failure to meet the policy’s definition of disability. Long-term disability policies often have specific criteria that define what constitutes a disability. If the claimant’s condition does not align with these criteria, RBC may reject the claim.
Non-compliance with treatment plans can also lead to denial. Insurance companies expect claimants to follow prescribed medical treatments and rehabilitation programs. If a claimant is perceived to be non-compliant or not making reasonable efforts to recover, RBC may use this as grounds for denial.
Pre-existing conditions are another factor. If the disability is related to a condition that existed before the policy was in effect, RBC might deny the claim based on the pre-existing condition exclusion clause in the policy.
Missed deadlines and incomplete paperwork can also result in a denied claim. The claims process involves strict timelines and detailed forms. Failure to submit required documents or meet deadlines can lead to an automatic denial by RBC.
RBC may also deny claims based on surveillance or social media evidence. Insurance companies sometimes conduct investigations to verify the legitimacy of a claim. If surveillance footage or social media activity contradicts the claimant’s reported limitations, RBC may use this as a basis for denial.
Another reason for denial is the lack of objective medical evidence. Some conditions, particularly those involving chronic pain or mental health issues, are difficult to measure objectively. If RBC believes there is insufficient objective evidence to support the claim, they may deny it.
What type of disability policies does RBC sell?
One of the primary types of disability insurance offered by RBC is private Long Term Disability (LTD) insurance. This type of policy is designed to provide a monthly income replacement benefit if the policyholder is unable to work for an extended period due to a disabling condition. LTD insurance typically kicks in after a waiting period, which can range from a few months to a year, depending on the terms of the policy.
Additionally, RBC provides Group Disability Insurance plans, which are typically offered through employers. These plans can include both short term and long term disability coverage, and they often come with additional benefits such as rehabilitation services and return-to-work programs. Group plans can be a cost-effective way for employees to obtain disability coverage.
RBC also offers Short Term Disability (STD) insurance, which provides benefits for a shorter duration, usually up to six months. This type of policy is intended to cover the initial period of disability, providing financial support until the individual can return to work or until LTD benefits begin.
Another option available through RBC is Critical Illness Insurance. While not strictly a disability policy, it provides a lump-sum payment if the policyholder is diagnosed with a covered critical illness, such as cancer, heart attack, or stroke. This payment can be used to cover medical expenses, rehabilitation costs, or other financial needs during recovery.
What legal strategies does Kotak Law employ to challenge RBC long term disability denials?
Kotak Law employs a comprehensive review of the insurance policy to challenge denials. This involves meticulously examining the terms and conditions outlined in the policy to identify any discrepancies or ambiguities that may have been overlooked by the insurance company. By understanding the exact language and stipulations of the policy, Kotak Law can build a strong case that highlights how the denial may be inconsistent with the policy’s provisions.
Another key strategy is gathering robust medical evidence. Kotak Law collaborates with medical professionals to obtain detailed reports and expert opinions that substantiate the claimant’s medical condition and the necessity for long-term disability benefits. This medical documentation is crucial in countering the insurance company’s assessment and demonstrating the legitimacy of the claim.
Kotak Law also focuses on procedural fairness. They scrutinize the insurance company’s claims process to ensure that all procedural requirements were met. This includes verifying that the insurer conducted a thorough and unbiased investigation, provided clear reasons for the denial, and adhered to all legal and contractual obligations. Any procedural lapses can be leveraged to challenge the denial.
Engaging in negotiations with the insurance company is another strategy employed by Kotak Law. They use their expertise in insurance law to negotiate directly with the insurer, aiming to reach a fair settlement without the need for prolonged litigation. These negotiations are often backed by the comprehensive evidence and legal arguments prepared by Kotak Law.
If negotiations fail, Kotak Law is prepared to take the case to court. They file a lawsuit against the insurance company, presenting a compelling case that includes all gathered evidence and legal arguments. Kotak Law’s experience in litigation ensures that they can effectively advocate for their client’s rights in front of a judge.
Kotak Law also leverages case law and precedents. They research and cite previous court decisions that are relevant to the client’s situation. By demonstrating how similar cases have been resolved in favour of the claimant, Kotak Law can strengthen their argument and increase the chances of a successful outcome.
Client education and support are integral to Kotak Law’s approach. They ensure that clients are fully informed about their rights and the legal process, providing guidance and support throughout the entire process. This empowers clients to make informed decisions and actively participate in their case.
Kotak Law works on a contingency basis
Yes, Kotak Law operates on a contingency fee basis, which can be particularly advantageous for clients facing financial strain due to a denied long-term disability claim. This means that you do not have to pay any upfront legal fees to retain their services.
Under a contingency fee arrangement, Kotak Law will only receive payment if they successfully recover compensation on your behalf. This aligns their interests with yours, as their payment is contingent upon winning your case or securing a settlement.
The contingency fee is typically a percentage of the amount recovered. This percentage will be agreed upon before the legal representation begins, ensuring transparency and mutual understanding between you and the law firm.
This fee structure can provide peace of mind for clients, as it eliminates the risk of incurring legal fees without a successful outcome. It also makes legal representation accessible to individuals who might not otherwise afford it, especially when dealing with the financial burdens of a denied disability claim.
Kotak Law’s contingency fee model underscores their commitment to fighting for your rights and obtaining the benefits you are entitled to. By working on a contingency basis, they demonstrate confidence in their ability to effectively advocate for your case.
If your long term disability claim has been denied by RBC call the lawyers at Kotak Law today for a free consultation.
