If your Long-Term Disability (LTD) claim is denied, it can be a frustrating and challenging experience. However, there are steps you can take to appeal the decision and pursue the benefits you need. Understanding the reasons for the denial and knowing how to navigate the appeals process are crucial to securing the benefits you deserve. Below we guide you through what to do if your LTD claim is denied.

Review the Denial Letter

Carefully reading the denial letter from your insurance company is the first crucial step after receiving a denial for your Long Term Disability claim. This letter should provide detailed information on the specific reasons for the denial, outlining the evidence or documentation that was considered in making the decision. It is essential to understand these reasons clearly, as they will form the basis of your appeal strategy.
The denial letter will typically include a summary of the findings from the insurance company’s review, highlighting any discrepancies or deficiencies in your original claim. This may involve medical records that were deemed insufficient, a lack of supporting documentation, or a failure to meet the policy’s definition of disability. By identifying these discrepancies, you can focus your efforts on addressing them in your appeal.

The denial letter should also outline the procedural steps for filing an appeal, including deadlines and required forms or documentation. Pay close attention to these instructions, as failing to adhere to the insurer’s guidelines can jeopardize your appeal. Be sure to note the deadline for submitting your appeal, as missing this deadline could result in the loss of your right to challenge the denial.

Additionally, the denial letter might include contact information for the insurance company’s appeals department or the representative handling your case. It can be helpful to establish communication with this contact to ask any clarifying questions and ensure that you understand the requirements for your appeal.

If you have misplaced or lost your denial letter don’t worry! You can contact your Long Term Disability insurer and request a copy.

Appeal the Decision

Filing a formal appeal with your Long Term Disability insurance company is a crucial step in challenging a denial of your Long Term Disability claim. An appeal means you are requesting that your insurer re-evaluates your claim. This process involves submitting additional evidence and a written statement that articulates why you believe the denial was incorrect. Here’s a detailed guide on how to effectively submit an appeal:

Gather Additional Evidence

Collecting additional evidence is a critical step in appealing a denial of your Long-Term Disability claim. Strengthening your medical documentation and providing comprehensive, up-to-date information can significantly enhance the chances of your appeal being successful.

Begin by reviewing the denial letter to understand the specific reasons for the denial. This will guide you in determining what additional evidence is needed. If the insurance company cited insufficient medical evidence, focus on obtaining comprehensive and detailed medical records that directly address these deficiencies.

Start by gathering any new test results that were not included in your initial claim. These could be recent diagnostic tests, imaging studies, or lab results that provide objective evidence of your medical condition. New test results can offer updated insights into your health status and support the severity and impact of your disability.

Request detailed statements from your healthcare providers. These statements should specifically address the reasons for the denial mentioned in the insurance company’s letter. Ask your doctors to provide thorough explanations of your diagnosis, the extent of your disability, and how it affects your ability to perform work-related tasks. Statements should be clear, specific, and detailed, offering a compelling narrative of your medical condition and its impact on your life.

In addition to medical documentation, gather any other relevant documents that can support your appeal. This might include letters from colleagues or supervisors attesting to the impact of your condition on your work performance, vocational assessments that demonstrate your inability to perform job duties, or any other documentation that reinforces your claim.

Prepare a Written Statement

Prepare a written statement that explains why you believe the denial was incorrect. Your appeal letter should begin with an introduction that includes your name, policy number, claim number, and contact information. State that you are formally appealing the denial of your LTD claim and briefly summarize the basis for your appeal.

In the body of the appeal letter, address each reason for the denial in a separate section. For each point, reference the specific evidence you are submitting that counters the insurance company’s findings. Use clear and concise language to explain how the new evidence supports your claim and demonstrates your inability to work due to your disability.

Make sure to emphasize any new or updated information that was not included in your initial claim. Highlighting this new evidence can strengthen your appeal by showing that you have addressed the insurance company’s concerns with additional, relevant documentation.

Ensure that your appeal is well-organized and easy to follow. Use headings and subheadings to break up the text and make it clear which evidence corresponds to each reason for the denial. Attach all supporting documents in a logical order, with a cover sheet that lists and briefly describes each item.

Submit your Appeal

Once your appeal is complete, submit it to the insurance company according to their specified procedures. This may involve mailing a physical copy, submitting it electronically, or both. Keep copies of all submitted documents for your records and consider sending your appeal via certified mail to confirm receipt.

After submitting your appeal, follow up with the insurance company to ensure they have received all necessary documents and to inquire about the timeline for review. Maintaining open communication with the insurance company can help ensure that your appeal is processed efficiently.

Why Your Appeal May Likely Fail

Appealing a denial of Long Term Disability benefits can be a challenging process, and unfortunately, there is a significant reason appeals often fail. Insurance companies have a financial interest in minimizing payouts, as their primary goal is to maximize profits. This inherent conflict of interest can significantly impact the handling of Long Term Disability claims. Since approving a claim results in a financial outlay for the insurance company, there is a built-in incentive for the company to scrutinize claims rigorously and, where possible, find reasons to deny or limit the benefits.

Seek Legal Advice

Consulting with a lawyer who specializes in disability insurance claims is a critical step if your appeal for Long Term Disability benefits fails. An experienced lawyer can provide a thorough evaluation of your case, examining all the details and documentation to identify any potential weaknesses or overlooked aspects that might have contributed to the denial. They can offer guidance on the next steps, including whether additional evidence or documentation might strengthen your case.

Your lawyer can also assess the likelihood of success in pursuing your claim through a lawsuit against the insurer. They will consider factors such as the strength of your medical evidence, the insurance company’s reasons for denial, and any legal precedents that might apply to your case. By evaluating these elements, your lawyer can provide a realistic assessment of your chances of winning a court case or negotiating a favorable settlement.

In addition to legal representation, an experienced lawyer can manage all communications with the insurance company on your behalf. This includes drafting and submitting further appeals, negotiating settlements, and, if necessary, representing you in court. Their expertise can be invaluable in navigating the complex and often adversarial process of securing LTD benefits.

Contact NOVA Injury Law Today & Get Support for Your Long Term Disability Claim

Navigating the complexities of Long Term Disability claims in Canada can be challenging, but understanding your rights and the processes involved is crucial for ensuring you receive the support you need.

If you have more questions or face challenges with your LTD application or benefits, call NOVA Injury Law today to book your free case review and learn more about your Long Term Disability claim!

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