Insurance Claim Denied? Here’s What You Can Do

by James Fireman


Monday, October 2nd, 2017 at 3:13 pm


Insurance Claim Denied – What Should I Do?

If you have Long Term Disability Insurance, or Short Term Disability Insurance, and your insurance claims have been denied, determining the proper steps to take after your claim has been denied can be very difficult. This is done entirely on purpose. Your insurance company is interested in one thing – making money. By making the process confusing, your insurance company knows that there is a better chance that you won’t take the proper steps, and won’t be entitled to recover the disability benefits that your are entitled to.

Why Not Just Appeal When My Insurance Claim is Denied?

In virtually every case, when your disability insurance claim is denied – whether it’s Long Term Disability or Short Term Disability – the denial will come with a letter inviting you to “appeal” your decision. This certainly sounds like the right steps to take, but is it?

long term disability, insurance claim denied

Think about it this way. The first decision – the one in which your insurance claim was denied – was made by your insurance company. Again, their interest is in making money, so if they can find an excuse not to pay you your benefits, they will. When you appeal their decision, in almost all cases, the “appeal” is simply the same insurance company reconsidering their decision. Your insurance provider’s interests haven’t changed at all – they still want to make as much money as possible. And because of that, you have no reason to believe that appealing the initial decision in which your insurance claim was denied will result in your insurance benefits being paid.

You Need to Move Quickly

So, what’s the harm in appealing? In Ontario, you have only two years – and in some cases, one one year! – from the date of the initial decision in which your Long Term Disability or Short Term Disability insurance claim was denied in order to start a lawsuit against your insurance company. If you don’t start your lawsuit within that time frame, the law says you aren’t allowed to sue your insurance company, even if you can prove you have a valid claim.

So when your insurance company denies your claim and invites you to appeal the decision, this is much less an opportunity for you to get your disability benefits (as again, the insurance company is not looking for ways to pay you money) than it is an opportunity for your insurance company to try to drag things out long enough that once the “appeal” process is over, you will no longer be entitled to bring a lawsuit.

What Should I Do?

The first thing you need to do when your Long Term Disability or Short Term Disability insurance claim is denied, is speak to a lawyer experienced in disability law. When you pick up the phone to call us for your initial consultation, you will get a chance to speak with an experienced lawyer who can help guide you through the process, and answer any questions you might have – and you are certainly going to have many questions.

There is no benefit to waiting to make the call either – the longer you wait, the longer it will be before your insurance benefits can be reinstated. And remember, if you wait too long, you might not be allowed to challenge the decision at all.

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But I Can’t Afford a Lawyer

Yes, you can. You don’t need to pay us anything out of your own pocket. When you call us, the initial consultation is ALWAYS FREE. More importantly, when we are your lawyers, you don’t pay us anything up front – we only get paid when we’ve successfully recovered your insurance benefits for you. Until your recover your benefits, we do not get paid anything. You have nothing to lose by calling us for your free consultation.

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James Fireman is a Partner in Samfiru Tumarkin LLP’s personal injury and disability law practice groups. Contact him directly at james.fireman@stlawyers.ca

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