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Appealing a Denied Disability Claim: Legal Strategies and Tips

You were counting on disability benefits to provide you with a financial safety net. You submitted your application for long-term disability benefits, and then you received the crushing news that your claim has been denied.


reviewing and signing a contract

The sad truth is that many valid disability claims are unfairly denied. Insurance companies are in the business of protecting their bottom line. They have a long list of reasons they use to deny claims. They make it tough to get approved and want you to think their decision is final.


Don’t give up if you are faced with a denied disability claim. You have options to appeal or challenge the denial, which our Barrie and Collingwood long term disability lawyers will explain below. Of course, if you want to know more or wish to discuss your own LTD claim, we welcome you to reach out to us today. You don’t need to navigate the LTD appeal process on your own.


Legal Strategies if your LTD claim has been denied

There are two core legal strategies for responding to an LTD claim denial. The first is requesting an internal appeal. The second is starting a lawsuit against the insurance company.

1.) Internal Appeal

An internal appeal is a request that the insurer re-examine its decision to deny your claim. The representative of the insurance company who made the initial decision to deny your claim is not involved. Instead, a new agent within the company is assigned to review the original decision and determine whether it should stand. If your internal appeal is successful, your claim is approved and the insurer begins paying LTD benefits to you.


The insurance company’s internal appeals process must be started within a set period of time; the deadline is typically 30 or 60 days from the date your LTD claim was denied. You must notify the insurer in writing of your intention to appeal its decision within that deadline, and then there will be another deadline by which you must submit any new medical evidence to support your appeal.  


Internal appeals are not recommended in all situations. For example, if the problem is a lack of medical evidence that you now have or a mistake in your application, an internal appeal may be the best strategy for overturning the denial. However, if the denial is rooted in something larger, such as a pre-existing injury or illness allegation, surveillance footage they say “proves” you aren’t disabled, or the insurer’s position that you don’t meet the “any occupation” test at the two-year mark in your LTD case, a legal claim may be the better strategy.


2.) File a Legal Claim Against the Insurance Company

You can file a lawsuit against the insurance company to appeal the denial of your long-term disability claim. When you do so, you are asking an independent decision-maker such as a judge or arbitrator to decide the issues—not a representative of the insurance company.


A legal claim is a great way to make the insurance company take your case seriously, as they will then have to spend money on a defence lawyer if they want to keep fighting your case. Insurance companies often approve benefits claims after legal proceedings are started, without the need for a trial.


You can first request an internal appeal, and then start legal proceedings if your internal appeal is not successful. But an internal appeal is not a prerequisite to your right to bring a lawsuit, and there is a risk that you may miss the limitation period to start legal proceedings while waiting on the insurance company to decide your internal appeal.

You only have two years from the date you were denied benefits to start a lawsuit against the insurance company. The insurance company is well aware of that two-year limitation period and will use the internal appeals process to run out the clock on your right to bring a lawsuit.


Tips if your LTD claim has been denied

Here are a few important tips if you have been told your LTD claim is denied:

  1. Get it in writing. If the insurance company did not provide you with a denial letter setting out why your claim was denied, demand one from them. You need to know the basis for their denial of your claim. You also need to know how long you have to take action. The internal appeal deadline should be stated in the denial letter (e.g., 30 days or 60 days from the date of the denial).

  2. Stay calm. Remember that you have options and your LTD claim can still be approved if you take the necessary steps to fight back against the unjust denial.

  3. Contact an experienced long-term disability lawyer for advice. Our lawyers can review your file, including the denial letter, the wording of your LTD policy, and the evidence you submitted to the insurer. We can help spot issues, correct mistakes, and shore up your medical evidence so that you put forward the strongest case possible.  We will also help you determine the best legal strategy to secure a successful outcome.



Barrie And Collingwood Long-Term Disability Lawyers Are Here To Help

Let us help you get the LTD benefits you deserve. We will stand up for your rights and advise you on the best strategy for getting your long-term disability claim approved.


Call us today at 705-725-7355 to set up a free initial consultation with a long term disability lawyer in Barrie. If you are looking for long term disability lawyers in Collingwood, we welcome you to make an appointment to meet with our staff at our law firm office located at 10 Schoolhouse Lane in Collingwood.


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