When your insurance provider denies your request for long-term disability (LTD) benefits, or decides to arbitrarily cut off your policy, the situation will seem confusing and hopeless. When this happens, insurance companies will often extend a supposed lifeline in the form of an appeals process.
What is an LTD appeal? Do you have to go through the process? Is there a better alternative?
The disability lawyers at Samfiru Tumarkin LLP have created the FAQ below to answer commons questions about long-term disability claims and the appeals process in Canada.
TABLE OF CONTENTS
2. Pros and cons of an appeal
3. Do I have to appeal an LTD denial?
4. Should I appeal a denial?
5. What happens if I don’t appeal?
6. Alternative to an appeal
7. How to get help
What is an LTD appeal?
When your application for LTD is denied, or when your insurer decides to cut off your LTD benefits, the letter or email advising you of the denial or stoppage of benefits will likely have a paragraph or two at the bottom explaining that you can “appeal” the insurer’s decision. It is very important to understand what this appeal means.
An appeal of an LTD denial is not a formal, objective and legal ruling on your right to LTD. It is not decided by a neutral third party (like a judge or an arbitrator), but rather by the same insurance company (sometime the person or group of people) who denied you in the first place.
What are the pros and cons of an LTD appeal?
Pros
The only pro of an appeal is that, if you succeed, the insurance company will provide you with the benefits allowed by your policy. You will not need a disability lawyer to represent you. However, in our experience, LTD appeals rarely work.
Cons
There are three major cons for an LTD appeal:
1. You are playing the insurance company’s “game”.
The decision-making power about the fate of your LTD claim rests with your insurer. This puts you at a great disadvantage because the insurance company has a very big incentive to not approve your claim. Remember that by denying your appeal, your insurer saves money because they do not have to pay your LTD benefits.
2. No neutral third party
Your appeal is not being adjudicated by a neutral third party. It is done internally, which means that the insurer can reject your claim at will, without any negative repercussions or penalties. Again, they have no incentive whatsoever to approve your claim on appeal.
3. Wasting valuable time
Most importantly, you waste valuable time when you appeal your LTD denial multiple times. The process can sometimes take months or even years. In some cases, when appeals drag out beyond a 2 year timespan, claimants lose their legal right to pursue legal claims against their insurance provider. This means that the insurance company has escaped liability and cannot be legally forced to pay the benefits they owe.
Do I have to appeal an LTD denial?
Generally, the answer is no. You should always seek legal advice before appealing. We provide this advice and review cases where claimant have been denied or cut off LTD benefits free of charge.
Should I appeal an LTD denial?
You should not appeal the denial of your LTD claim if you can avoid it, which is possible in most cases.
Appeals of LTD denials are, in our experience, useless. That is not to say that appeals never succeed. After all, some people win the lottery or get struck by lightning.
Appeals rarely work
In our experience, appeals rarely work, because the insurance company that decides the fate of your appeal has an incentive to reject it. The more appeals they reject, the higher the likelihood that claimants, such as yourself, may walk away from their LTD benefits, thus leaving money in the insurance company’s pockets.
Many insurers will allow you to appeal, re-appeal, and re-appeal again their rejection of your LTD claim. The more times they reject your claim, the more likely it is that you will get frustrated, angry and feel like there is no possibility of making your insurer pay the LTD benefits that you are owed.
Deadline to get compensation
The appeals process may also cause you to miss a very important deadline: the 2 (two) year limitation period for staring a legal claim to force your insurer to pay you what you are owed. Do not miss this limitation period under any circumstances. If you do, you will likely be statute-bared from recovering the LTD benefits owed to you by law.
We provide free consultations on all cases where a claimant has been denied or has been cut off (or advised that they would be cut off LTD benefits).
WATCH: Disability lawyer James K. Fireman explains why you should avoid appealing an LTD claim denial on a Season 3 episode of the Disability Law Show.
What happens if I do not appeal an LTD denial?
It depends. If you do not appeal an LTD denial and do not pursue legal action against the insurance company for failing to pay your benefits, your insurer will not pay you what they owe you.
We always advise claimants to pursue their LTD benefits by way of a legal claim. It is the most efficient way to force an insurer to comply with the law and pay what they owe legally.
What is the alternative to an appeal?
The alternative to an appeal is a legal claim. That means that we start a legal action against the insurer through the court system. This is a much more powerful and efficient way to force your insurer to pay what you are owed. Why? Because once we start the legal process, the insurer must appoint a defence lawyer to defend the legal claim, which means that the insurer must pay their lawyer.
We have found that insurance companies despise the idea of paying their lawyers, especially when they know that they will likely need to settle your case at some point. Moreover, once we start the legal process, insurers understand that if your claim ever went to court, a judge could easily order that they pay what you are owed, plus a portion of your legal fees, plus, in some cases, additional extra-contractual damages (i.e., punitive and aggravated damages) against them.
The reality is that the vast majority of cases do not go to court. They settle. Legal claims force insurers’ hands, which our experience has shown is the best and most efficient way to bring them to the negotiating table to secure the money that they owe.
Questions? Concerns? Contact Us!
If you are experiencing an issue anywhere in Canada (excluding Quebec) with your long-term disability claim, your employer or the insurance company, we’re here to help. Call our team at 1-855-821-5900, email Help@DisabilityRights.ca, or contact us online for a FREE consultation.
You can also post your specific question about your long-term disability claim online for a quick answer by a disability lawyer at Samfiru Tumarkin LLP, at MyDisabilityQuestions.com.
As Canada’s most positively reviewed disability law firm, we have the experience, tenacity and determination required to provide you with the advice you need, and the compensation you deserve.
Areas Served in Canada
Our team of experienced disability lawyers can help individuals in all Canadian provinces (excluding Quebec) when their long-term disability benefits are denied or cut off.
Alberta • British Columbia • Manitoba • New Brunswick • Newfoundland & Labrador • Nova Scotia • Ontario • P.E.I. • Saskatchewan