My LTD Claim Has Been Denied – What Do I Do Now?
If you have applied for Long-Term Disability (LTD) benefits following a serious injury or health issue that has prevented you from working, it is extremely disheartening and stressful if your LTD insurer denies your claim at the outset.
Often, people will give up at this stage. They think the insurer has made a final decision and that there is nothing they can do. However, there are steps you can take to dispute an initial denial, and an experienced long-term disability lawyer can help you achieve the best possible outcome.
If you’re told that your claim for LTD benefits has been denied, your first step is to get the insurer’s denial in writing. The denial letter will outline the reasons why the insurer is not approving your claim and allow you to know the case you have to meet in order to successfully challenge their decision.
Most often, the insurer disagrees that you meet the proper medical definitions to receive benefits under the policy. However, there can also be other reasons, such as problems with coverage under the policy, which should be identified at the outset.
- Next, you (and your lawyer) should review the clauses and definitions under your LTD policy. The policy will set out certain parameters for your LTD claim, including:
- Whether you fall under the “own occupation” or “any occupation” definition of disability;
- The amount of the benefit you should receive;
- The termination date for your benefits;
- Exclusions which may apply to your specific case; and
- Timelines for any appeals process.
After reviewing the policy, you should submit an appeal in writing. Your appeal should address the reasons for the denial and include supporting medical records. Ideally, these medical records would include a description of your disabling symptoms, impairments and the impact on your functioning and ability to work.
After receiving your written appeal, the insurer may decide to change its mind and approve your LTD benefits. Unfortunately, insurers often maintain their denial at the appeal stage, despite new medical evidence.
If your appeal is not successful, it will likely be necessary to start a lawsuit against your insurer to ensure your rights are protected and to fight for the benefits to which you are entitled.
Keep in mind there are very strict time limitations within which to start a legal action — the sooner you act, the better.
If your insurance company has denied your claim for LTD benefits, contact the experienced long-term disability lawyers at Ross & McBride LLP to assist you.
This article was originally published by The Hamilton Spectator.
