How to appeal a long term disability denial_.

When you’re forced to leave work because of an injury or illness, the expectation is that income from the disability plan you paid into will be available to you while you focus on recovery. However, the reality is that many people are denied their LTD claim either from the onset of their claim or as a result of a change in the definition date.

Note: The change of definition date typically refers to the change from the ‘own occupation’ definition to the ‘any occupation’ definition. At this point, benefits are only payable if you can’t work at ‘any occupation’ for which you have the required education, skill set, or experience.

If your insurance company has denied your LTD claim, you can appeal this denial. A personal injury lawyer can help you navigate the appeal process and determine the best course of action.

Step 1: Hire a personal injury lawyer

Whether you are facing an initial appeal or potential legal action, a personal injury lawyer can evaluate your situation and determine the strengths and weaknesses of your case. Remember, the insurance company deals with denials every day, so hiring an experienced insurance lawyer who fights daily against insurance companies for those denied their benefits puts you on an equal playing field with your insurer.

Step 2: Identify the deadline for your appeal

Your lawyer will help you identify the deadline to begin the appeal process, typically stated in your denial letter, and will help you gather all necessary information.

If the company denies your benefits over the phone, ask the representative to put the denial in writing so that you know definitively when the deadline is, and have proof to support your claim.

The deadline will be written in one of two ways: Either as a specific date (for example ‘June 5, 2021’) or as a certain number of days from the date of the denial letter (for example ‘60 days from the date of denial’).

Step 3: Know when to appeal

Your lawyer will help you determine whether you have a viable appeal. Your lawyer will review the case facts and determine if there is new evidence that has not yet been provided to the insurance company, such as updated medical information from doctors or specialists. New information from a medical specialist can go a long way in overriding your claim denial.

Your lawyer will also determine if/where an application mistake may have been made. An example could be if your employer entered the wrong information, which led to a denial.

Step 4: Gather your appeal documents

Each case is unique which means that the documentation required for your appeal may differ from another appeal case. However, the most common documents for preparing your appeal letter include:

• The denial letter from the insurance company
• A copy of your group insurance, describing your LTD benefits
• A copy of your insurance company’s ‘claim file’ (if possible)
• Your union’s collective agreement (if you are part of a union)
• A copy of your doctor’s medical file from the date your symptoms started impacting your ability to work.

Tip #1: Financial planning

A long-term disability appeal takes time to resolve. During that time, you’ll be without income because your LTD benefits have been denied or cut-off. If you win your appeal or lawsuit, you may be paid in arrears (from the date of the denial). However, we understand that this doesn’t help you in the short-term. This is why it is important to consider other sources of income, like Employment Insurance sickness benefits, to provide you with income while you await your appeal decision. Doing so can reduce your financial stress during the legal process.

Tip #2: Writing an LTD appeal letter

When writing an appeal letter, it is important to be clear and concise while ensuring you respond to the reason for your denial.

You should write your appeal in a business letter format which includes the date, your address, your insurer’s address, and a “re:” line with your claim and policy numbers at the top of the letter, can go a long way in helping to simplify the appeal process.

Use this letter to directly address the reason for your denial. Remember, the insurance company has been through some of your files already and have some picture of your situation. Focus on addressing the specific reasoning for the denial. For example, if your denial is based on the insurance company not feeling your disability limits your ability to work, explain examples of how it does just that. If you work on your feet and your disability doesn’t allow you to stand for more than an hour at a time, explain this in the letter.

Further, use this letter as a chance to clarify your situation and provide details. Provide additional relevant information that has not yet been considered. Clarify anything that has been overlooked or misinterpreted.

Finally, be truthful. Remember, your claims handler works for the insurer. If you have been denied, likely, they do not yet have sufficient evidence to prove your injury or illness. Do not exaggerate your condition in your appeal letter. Doing so may make your insurance company more suspicious and skeptical. Try not to be argumentative or lay blame in your letter, either, as that can cause misunderstandings.

For help with appealing your LTD denial from a team with decades of experience battling insurers, book a free consultation.