How to Appeal Your Long Term Disability Denial
Have you filed a claim for disability benefits and recently learned that your insurance company denied your claim? This is disappointing news of course and you are likely wondering what to do next. Keep in mind that just because the insurance company decided to deny your LTD benefits, that does not mean you should accept the decision. Why? Many disability claims are denied by insurance companies even though benefits should have been awarded. Denials are a tactic used by insurance companies to have disabled workers walk away from their benefit – which saves the insurance company money. While feeling defeated and disheartened is common after learning about a claim denial, don’t consider the denial decision as final.
If your long-term disability claim has been denied and you would like to file an appeal, here are five steps to appeal LTD denials, along with links to additional resources to appeal disability claim denials.
Contact the Disability Appeals Lawyers at NOVA Injury Law today
When they find out that their insurance company has denied their disability claim, many who have filed for long-term disability benefits feel discouraged and fail to take action. They may believe that their options have been exhausted; others may be tired of struggling and simply ready to concede to defeat.
Even if you feel down and defeated, don’t give up. You should never make an important decision about your disability benefits without knowing about your rights, what options are available to you, and what resources you can access to overturn the wrongful denial of your long-term disability benefits. This is where an experienced disability appeal lawyer can help you.
Insurance policy documents are long and deliberately complex. Terms may not be clear, definitions hard to find, and learning what provisions apply to your claim may be vague. The best and most accurate way to understanding the key provisions that apply to your claim and the maximum policy benefits amount is to seek the help of a lawyer experienced in the area of disability insurance. The right lawyer for your LTD case can level the playing field and successfully navigate the complex policy roadblocks the insurance companies intentionally put in your way to achieving success. Without a lawyer on their side, claimants are at the mercy of their own limited knowledge and may be taken advantage of by the insurance company.
If your disability claim has been denied, you will likely be given the opportunity to “appeal” the decision by providing additional medical information to the insurance for the insurance company to review. While there is a small chance that the case manager assigned to your long-term disability appeal claim will reverse the decision, in most cases, it simply further delays the matter while ending with the same result; a denial of disability benefits. Of course, while the insurance company considers your entitlement to benefits you will be without disability payments for months which only puts more financial pressure on you.
As lawyers who practice long-term disability law, we cannot overemphasize the value of seeking the help of experienced disability appeal lawyers. We often take on cases after disabled workers have tried for months to access their benefits without success. We see the lost time, frustration, and wasted energy spent to get no further with the insurance company. We respect that some claimants may not want to hire a lawyer because it may add more complexity to an already challenging circumstance. However, most disabled workers see that hiring the right lawyer adds considerable strength to their case right away. A disability appeal lawyer can make sure your claim is filed properly, cut down on the delay, and help your claim proceed more smoothly.
Our legal team is contacted by disabled workers at every step in the process – even by some who are still at work and wanting to learn more about their ability to make a claim. If your claim has been denied, we encourage you to contact us as soon as you have received a denial letter or email advising you that your benefits are being denied or terminated. Be sure to tell us about any deadlines in the letter sent to you by the insurance company. You may also have limits on your ability to appeal the decisions. Many people find the denial letters from the insurance company both confusing and upsetting. We will help you to know what is most important.
The information in the long-term disability denial letter can be rather confusing regarding deadlines but it is important to be sure that you haven’t missed any deadlines that could prevent you from being able to pursue your disability claim. In many cases, the denial letter will state that you must appeal the decision within 30 – 60 or 90 days and provide additional information from doctors and specialists in order to have the insurance company reconsider their decision to deny your claim. These deadlines can be negotiated with the insurance company in many cases, but they should not be ignored without good reason if you do intend to file an appeal.
What do we suggest? Our advice is to never delay contacting our experienced team to help you know where you stand. Our consultation and case review process is completely free. We will review your insurance information and even send your medical records to our in-house doctor. There is no cost and no obligation to learn about your rights! You’ll learn how we think we can help you win your disability claim.
Get Detailed Records and Documentation From Your Doctors and Specialists
It is important that you provide as much documentation as possible when applying for long-term disability or appealing a denied disability claim. You will want to ensure that all relevant medical information has been provided to the insurer. This will often mean updating the information on file and gathering additional evidence from specialists. Remember, the test for disability is whether or not you are totally disabled from your occupation or any other occupation, depending on the provisions of the policy. You will want to try to have your doctor and specialists link your medical condition to the reason you cannot complete duties at work.
Gathering your medical information for a disability appeal will cost money. Expect to pay physicians and hospitals for the medical information. The cost varies based on the size of the medical file, how long the information takes to review, and how you wish to receive the records.
Important documents to order often include:
- Up-to-date clinical records
- Records from any hospital or specialists
- List of medications that you are taking
- Copies of diagnostic tests, scans, x-rays, and bloodwork
- Copies of all correspondence from and to your insurance company
- Notes of your conversations with the insurance companies and your doctors and nurses
A journal in which you keep track of your symptoms, doctor visits, and progress. Journaling is especially important for claims without apparent physician injuries, including chronic pain, fibromyalgia, PTSD, and other mental illnesses.
In addition, a narrative report from your specialist or primary physician is often the best evidence on appeal. That report should contain not just your diagnosis and that physician’s opinion on key questions, including:
- how you have responded to treatment
- how your disability impacts your function at work
- how your disability impacts your function at home
- your prognosis
- what future care options and assessments are available to you available
Of course, it is important that your doctor conduct a thorough medical examination and refer you to the appropriate specialist for your disability. Your doctor should be the one to make an assessment of your disability and provide specific information about why you cannot work. Your doctor will never have the same level of familiarity with the workplace as you do. You must educate your doctor about your work duties and why you can no longer complete your usual tasks.
Be sure that any medical information you give to your insurance company be complete and accurate. Read all information prior to submission ask ask yourself whether the information is an honest account of your challenges? Many of our clients understate their disability because they hope the insurance company will be more apt to approve their claim. Others have their own optimism get in the way of providing a true account of their medical condition. Both of these approaches are sure to cause problems and delay the route to claim approval.
What if your doctor completes their assessment and determines that you are not disabled? Don’t worry! You must find out why your doctor reached his or her conclusion. Perhaps your doctor doesn’t understand the challenges of your job, or maybe they have other reasons in mind why your claim will succeed. Bes rue to learn as much as you can as the information will be very important when completing your free Case Review Process with our legal team.
Why does my doctor not support my disability claim?
Some of the main reasons why your doctor may not support your claim are below:
- Unclear expectations: Perhaps your doctor does not understand their role in the process or what is expected of them. They may not want to complete long forms with confusing insurance terms. Perhaps they expect that they will be contacted by the insurance company on a regular basis and it will interrupt their time seeing other patients. You can help your doctor by helping him or her with the forms and ensuring that you will attempt to make any requests by the insurer easy to complete.
- Concerns about their medical management: Let your doctor know that their opinion on your disability has no impact on their standing with the College of Physicians. The insurance company is simply attempting to determine whether or not you qualify for benefits based on the eligibility criteria of the plan – not whether or not your doctor has been providing medical care to the standard expected by the insurer.
- Lack of time: No one likes doing paperwork all day. Perhaps your doctor is concerned that the process of assisting with a long-term disability claim will take up too much of their time and take away from patient care. It may be that your doctor hasn’t been asked to complete an LTD form before and they are unsure what to write. We find that coming to the appointment with a list of your restrictions and limitations helps doctors appreciate the issues and write letters supportive of your disability. A little prep work on your part goes a long way!
- Medical opinions about your disability: Your doctor went to medical school and is not part of the insurance industry. Your doctor may not know the test for disability, be it the one that is part of your long-term disability plan or the Service Canada test for Canada Pension Plan Disability. not understand that your disability has limited your ability to work. You can help your doctor by bringing a copy of the denial letter with you to the appointment. Highlight the test for disability to make it even easier for your doctor.
- Personal opinions: Your doctor might have a personal bias against those who receive disability benefits and does not want you labelled as disabled. While your doctor may be coming from the right place, you must insist that they proceed with an assessment and clearly explain your medical issues to the insurer.
- Money: doctors are allowed to charge for letters and forms they complete.. The insurance companies often reduce to pay for any expenses related to collecting evidence for your application or appeal. Unless the amount is completely unreasonable our advice will be to pay the amount requested.
You owe it to yourself to ensure your doctor knows everything that you have had to contend with as part of the disability claim process. By keeping a record of your appointment and discussions with your doctor and specialists you can help ensure that action points from conversations are followed through and information to help your case is provided to you or the insurance company.
The legal team at NOVA Injury Law focuses on long-term disability law. We have experience in gathering information from your doctor, hospitals, and specialists. We take the time to explain the importance of the process to your health care team and do what we can to make the process easy for them. If the medical information process occurs properly you can greatly increase the chance your claim will be approved in less time.
Other Disability Benefits Programs
Canada has various federal programs that offer monetary relief and other benefits to disabled workers on either a short-term or long-term basis.
Canada Pension Plan Disability Benefits
Canada Pension Plan disability benefits may be available to you if you have made enough contributions to CPP over several years. The CPP Disability benefits have a medical test for disability which requires the application to have a disability that is both “severe” and “prolonged,” and must prevent you from being able to work at any job on a regular basis. Applying for CPP disability benefits may also strengthen your case against the insurance company. You can obtain the application online here.
These benefits are reserved for Canadians whose disability is in some way related to their service in the military.
EI Sickness Benefits
Employment Insurance (EI) sickness benefits can provide you with up to 15 weeks of financial assistance if you cannot work for medical reasons. You could receive 55% of your earnings up to a maximum of $595 a week.
There are also provincial and territorial programs that offer monetary relief and other benefits to workers with short term and long term disabilities:
Most provinces offer workers’ compensation for those who are injured or fall ill due to events that occurred while they were at work. Not all employers are covered by workers’ compensation so you will have to check your employer’s status with Board in your province or territory. The funds are expected to cover medical expenses (including the purchase of medical equipment), and to make up for lost income during the recovery. Most workers’ compensation programs expect that the employee will eventually return to work at some point. You can find a list of contact points for the provincial board in your location here.
Disability Support Programs
These programs cover costs of living and other expenses for people with severe disabilities and are usually set aside for people with financial needs. That can make them more difficult to qualify for than some of the other programs, but it also means that they can be an essential source of support for people who are struggling.
The programs in the Atlantic Provinces are the following:
Government of Nova Scotia Disability Support Program
Government of Nova Scotia, Community Services Direct Family Support for Children
Nova Scotia Association for Community Living
Prince Edward Island
Many welfare programs are run at the municipal or local level, rather than by the province. Each town, city, and county can have its own procedures for distributing funds, as can First Nations territories.
You must get a medical certificate to show that you’re unable to work for medical reasons. Medical reasons include illness, injury, quarantine, or any medical condition that prevents you from working.
Do Follow Your Doctors’ Treatment Plans
Most disability policies contain a provision requiring claimants to be under the continuous care of a medical doctor. It may also require the claimant to be participating in reasonable treatment. Don’t let the insurance company deny your claim because you have decided to give up on treatment due to the frustration of the disability claim process. You must remain under the regular care of a physician which means attending appointments and considering reasonable treatment options.
In order to avoid facing a denial from the insurance company because you were non-compliant with the provisions of the policy, you should make all efforts to ensure that you are receiving and following the treatment plan that is being prescribed for you. This does not mean that you must do everything your doctor says. Having said this, if you disagree with your physician’s opinion you may want to consider obtaining a second opinion to ensure that you remain actively under care by a supportive physician. Maintaining regular check-ups with your doctor and specialists and make sure that you document all of these appointments. Do not miss appointments and make sure that you reschedule appointments as soon as possible if your schedule changes. If you must miss an appointment, call the doctor’s office to apologize and tell them why you were unable to make the appointment. Being a good patient will go a long way in your treatment and in your disability claim.
If access to medical care prevents you from complying with this requirement, you should document all of your efforts to obtain appropriate medical treatment and if you cannot obtain it, you should also document the reasons why if at all possible. Otherwise, it will be much more difficult for an insurer to rely on this type of defence for a valid disability claim.
Do File Your Appeal. Never Give Up Hope.
Appeals are often unsuccessful and can take many months. If you cannot work due to a disability and have already gone through a challenging claims process only to find your claim is denied, you may feel you are ready to throw in the towel and try to move forward without disability benefits. Many disability claims are denied when first submitted. Individuals with no experience with disability claims can, understandably, feel intimidated by large insurance companies and overwhelmed by their claims process. Despite your best efforts, you have now been denied the benefits you feel you’re entitled to. You may even feel confident that you aren’t in fact disabled after reading about the insurance company’s medical consultants and their opinions (even though they likely never met you!) Of course, you don’t get to make any of these decisions when you’re at your best. We understand that you are burdened by your disability and attempting to navigate a challenging insurance claim process while also attempting to keep your symptoms in check.
Carry through with your claim and don’t lose hope. People from every type of work struggle with disability claims. The reality is, if people were treated fairly there would be no need for disability lawyers at nOVA INjruy Law to help disabled workers through an unjust system. We understand that you, nor anyone else, wanted to be disabled. You did, however, expect to be able to rely on a benefit if you were disabled and needed financial support.
We encourage you to seek legal advice as soon as possible because there is no downside in doing so! Hiring a lawyer can help ensure that you receive the compensation that is owed to you, and determine what your case is worth. A lawyer can assess your situation, and use that information to tell you how long your case is going to take, and what the value of your case will be should you be reinstated or consider a buy-out of your policy. The first step to know where you stand is to have an appreciation of the law applicable to your case. NOVA Injury Law will help you negotiate for compensation while ensuring that it is a fair amount for your case.
At NOVA Injury Law, our Case Review is just the first step on the road to success. Throughout your case, you will know where you stand and what to expect next. We know how important communication is doing any claim process- and especially one as important as a long-term disability claim. You will be matched with an experienced disability lawyer for your case. YOu will work with your lawyer and have direct access to your lawyer from Day 1.
Do you still feel like giving up? Don’t be tempted. Let us take the burden off your shoulder and do the best we can to achieve a fair result for you. Our talented team of experienced long-term disability appeal lawyers at NOVA Injury Law is ready to help you today.
The best thing you can do for your claim now is to have the help of an experienced disability lawyer. Our disability lawyers only practice in the area of disability and injury. This means that we know how to fight against insurance companies and achieve excellent results for our clients. Our objective at NOVA Injury Law is to handle the legal work while you focus on your recovery. Our team of long-term disability appeal lawyers is here to help you every step of the way so you don’t have to feel the stress of going against the insurance company on your work.
If you have had your claim for long-term disability denied, contact the long-term disability insurance lawyers at NOVA Injury Law. Our experienced team of long-term disability (LTD) lawyers can help you today to overcome your denial or pending termination. We have recently settled cases against Sun Life, Manulife, Canada Life, Desjardins, RBC Insurance, Life Insurance of North America, and many others. We offer free Case Reviews and there are no fees unless we win your case. Wondering if you have a case? Find out by clicking here.