Treating disability

Your Long-Term Disability Was Denied. Now What?

A long-term disability claim might not be a magic wand that just makes everything better, but it does ease some of the stress, strain, and financial anxiety of dealing with a permanent or semi-permanent condition. You could receive between 60% and 70% of your pre-disability income each month, depending on your policy. This may be paid until you’re fit to work again or until you reach retirement age – a welcome boost at a difficult time.

But what happens if your long-term disability claim is denied? This is a traumatic experience that many Canadians have had to deal with, and it can be difficult to know where to turn. Fortunately, there may be a solution – an appeal.

You don’t have to go through this alone; Allan Rouben is here to help. Read on to discover more about long-term disability claim appeals, and to find out what steps you can take if your claim is denied. 

Why Long-Term Disability Claims Get Denied

So why does this happen? Why do long-term disability claims get denied? There are a number of common reasons for this:

Insufficient Medical Evidence 

When you submit your claim, you’ll need to provide medical documentation and evidence to show that you are unable to work. If there is not enough medical evidence to support your claim, it may be denied.

Policy Definitions and Exclusion

Each disability insurance policy is different and may have its own definitions of key terms. So, if your policy’s own definition of a medical condition does not match your symptoms or experience, the claim may be denied. Some policies may also exclude certain pre-existing conditions or other complaints from their coverage.

Failure to Follow Treatment Plans

There may be certain conditions attached to your claim. For example, you may be prescribed a treatment plan that can help you return to work. If it is decided that you haven’t followed this treatment plan, the claim could be refused.

Surveillance and Social Media 

Insurance providers have a number of methods that they use to assess claims. They may use surveillance, reviewing publicly available footage or records, or monitoring social media. This evidence may then be used to dispute a claim.

What to Do If Your Long-Term Disability Claim Is Denied

Receiving a rejection on your long-term disability claim can be heartbreaking, but this doesn’t need to be the end of the line. Here’s what you should do if your claim is denied.

Review the Denial Letter Carefully

It’s vital that you understand exactly why your claim was denied. As we’ve touched on above, there are many reasons for a potential rejection, and they are all very different. Read the letter carefully and identify the specific reason in your case.

Collect Additional Evidence

Once you know why your claim was rejected, you can start gathering evidence to support your appeal. For example, you may gain access to your comprehensive medical records, or you might find proof that you did in fact follow the treatment plan. You may seek a second opinion from an expert, who may be able to confirm that you are not fit for work. Remember that this proof should relate directly to the specific reason your claim was denied.

Consult with a Disability Lawyer

Consulting with a disability lawyer is an important step. Professionals like Allan Rouben can provide a detailed and professional evaluation of the denial so that you understand exactly what you are facing. This can ease some of the anxiety and worry. Allan will also help you to strategize your appeal, planning what can be done to achieve the best possible outcome.

What to Expect During the Appeals Process

If you believe your claim was wrongfully denied, and you opt to appeal the insurance company’s decision, what happens next? Here’s what you can expect:

The Appeal Timeline

Each appeal will have its own specific timeline, but a typical process may look like this:

  1. It can take between 45 and 105 days for the disability insurance provider to process your claims.  
  2. If you are denied, you have 90 days to launch your appeal. 
  3. The first stage is usually an internal appeal, where you speak with representatives from the insurance provider in an attempt to overturn the decision. 
  4. If this is unsuccessful, you may decide to take the appeal to litigation – you will have up to one year to begin this case, starting from the date at which your claim was denied. 

The Role of Legal Representation

Allan Rouben will help you navigate the appeals process, offering advice and guidance along the way. He will use his legal expertise to present a compelling case on your behalf, and his services will be invaluable if the case proceeds to litigation.

Potential Outcomes

How will the appeal end? Take a look at a few common outcomes:

  1. The denial is overturned – You are awarded your long-term disability benefits.
  2. You reach a settlement – The claim denial still stands, but the insurance company pays a mutually agreed amount instead.
  3. The appeal is escalated and proceeds to litigation – If a mutually agreed outcome is not reached by the appeal, legal action may be required, and your disability lawyer will help you navigate this process.

Long-Term Disability Denied? Start your Appeal Today

If your long-term disability claim is denied in Ontario, Allan Rouben is here to help. With extensive experience and leading legal expertise, he can help you navigate the complexities of the appeal process, supporting you as you move toward the best possible outcome.

You’re not alone in this. Call on Allan Rouben today and get your free consultation. This is your first step toward a brighter future.

Long-Term Disability Claim Denial FAQs

    How long do I have to appeal a denied claim?

    Typically, you will have 90 days to launch your appeal after you receive the denial letter, and up to one year to file a legal claim.

    Do I need to provide new evidence for my appeal?

    Each appeal is different, but in some cases you may need to provide new evidence.

    Can I appeal if I miss the deadline?

    You may not be able to launch an internal appeal if the deadline is passed, but you may be able to launch a legal claim if you believe there was gross malpractice, negligence, or another reason that caused the claim to be wrongfully denied. Insurance companies don’t like to go the litigation route, and they may offer you a settlement instead. Allan Rouben can help you explore your options. However, it is best to remain within claiming deadlines where possible.