3 Ways to react to an LTD denial | Disability Law Show TV – S4 E20

Episode Summary

3 WAYS TO PROPERLY REACT TO AN LTD DENIAL on Season 4 Episode 20 of the Disability Law Show with disability lawyer and national co-managing Partner Sivan Tumarkin.

Watch above to discover the steps you need to take when the insurance company cuts off or denies your long-term disability claim in Ontario, British Columbia, or Alberta, on the only disability law show on TV and radio in Canada.

Episode Notes

Cut off of LTD despite own occupation provision in the policy

I’m a family doctor and about 2 years ago my husband passed away. I have a private LTD policy that allows me to collect LTD payments until the age of 65 if I can’t work in my own occupation for the entire period. The insurance company has cut off my benefits as they believe I can do something else. How is this possible?

• Terms in a disability policy: Some private disability policies have an “own occupation” provision which, unlike regular disability coverage, does not require individuals to be able to prove they are unable to work in other positions. In standard disability policies after two years of long-term disability, most claimants will have to prove they are unable to work in any occupation. The insurance adjuster in this situation does not understand the claimant’s disability policy and the provision included. Many claimants who are experiencing mental health illnesses have added pressure when dealing with difficult insurance adjusters. By beginning the legal process, claimants can focus on their own health and progress.

Told to file a second appeal after the denial of LTD

The insurance company just rejected my appeal of their decision to deny my LTD claim, even after I provided medical notes about my ailment from a second physician. They’ve offered me the opportunity to file a second appeal. Is it worth another shot?

• Appeal after a denial of benefits: It is important for claimants to realize that many individuals mistakenly believe that insurance adjusters take the appeals process seriously. Appeals are rarely effective and generally waste a claimant’s time and energy. The appeals process was created by the insurance company and the appeal in question is not reviewed by an external objective party. Rather than begin the appeals process, claimants should consider beginning a legal claim.

3 Ways to properly react to an LTD Denial

• Do not assume that the insurance company is right: Claimants should try and challenge the insurance company after the initial denial for the reason that they have been denied long-term disability. Often upon denial, the insurance adjuster will provide a reason or many reasons for why the benefits have not been approved. This denial letter and justification can be used by a disability lawyer in building a case to seek disability benefits.
• Pressured into appealing the decision: It is common for insurance companies to push claimants to appeal an LTD denial. By appealing, claimants are doing what the insurance company wants them to do which is waste their own time. Claimants have up to two years to pursue their benefits after the initial denial of benefits. Appeals are rarely effective and are not conducted by an external party.
• Begin a legal claim within the appropriate period: Claimants in some cases are either traumatized by the denial or have wasted a lot of time appealing the denial of their benefits. Claimants have up to two years to pursue their benefits after they have been denied. By hiring a disability lawyer the process becomes easier and more efficient for claimants. Legal claims rarely lead to court as insurance companies do not want a claim to be reviewed by a judge or pay additional damages.

Diagnosed with MS but denied LTD as considered not totally disabled

I was diagnosed with MS around the same time I started a new job. The first few years were fine but now the intensity of the symptoms seems to be increasing. I applied for LTD but was denied by my insurer as they believe I am not “totally disabled”. How is this possible?

• Confusing terminology used by insurers: The idea of “total disability” is an invented term created by insurance companies. In a disability policy context, total disability does not mean a claimant is unable to do anything or function at all. The claimants’ doctors themselves are unaware of what the term “totally disabled” truly means. To be totally disabled in relation to a disability policy means a claimant is unable to perform the basic tasks of their own occupation in the first two years of disability leave and then any occupation after the first two years. Some illnesses, like MS, are complex and can progress over a period of time. Claimants who have progressive diseases and have the support of their doctors should speak to a disability lawyer as soon as possible.
  • LEARN MORE ABOUT
    Disability Law Show Season 4 – Common Terms and their impact on Your LTD claim

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Previous Episode: Disability Law Show S4 E19 – 3 Facts about insurance adjusters that can help your claim