In the bustling metropolis of Toronto, where the daily grind often feels incessant, the possibility of experiencing a debilitating illness or injury is very real.
For those unfortunate enough to find themselves in this position, long-term disability benefits (LTD) can be a lifeline. But what happens when your insurance provider unjustly denies these benefits?
Let’s dive into the key facts every Torontonian should know if they find themselves faced with a denied LTD claim.
1. Legitimate long-term disability claims can’t be arbitrarily denied
If you’ve been paying into a long-term disability plan and meet the criteria set out in the policy, your insurance company can’t arbitrarily reject your claim.
Remember, an insurance contract is a two-way street. While you’ve upheld your end of the bargain by paying premiums, your insurer has an obligation to pay out valid LTD claims.
Sometimes, insurance companies in Toronto and the Greater Toronto Area (GTA) will assert that there isn’t enough medical documentation to support the disability claim – emphasizing the importance of comprehensive medical records from your doctor and frequent check-ups.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
At other times, insurers may point to specific policy exclusions, such as pre-existing conditions or particular ailments. Always familiarize yourself with these to ensure your claim isn’t inadvertently falling into an exclusion zone.
Additionally, insurance companies might argue that while you may have a health issue, it isn’t severe enough to qualify for long-term disability.
In such cases, thorough documentation detailing the impact of the disability on daily life can be invaluable.
If your insurance provider identifies one or more reason to turn down your LTD claim, don’t lose hope. You have a right to ask questions and learn more about their decision.
An experienced disability lawyer at Samfiru Tumarkin LLP knows the right questions to ask. We provide free consultations and can help you determine if your insurer has made mistakes when denying your claim.
READ MORE: Long-term disability denied in Ontario? 3 things to do
2. Always get the denial in writing
If your insurance company denies your LTD claim, ask them to provide you with their reasons for the decision in writing. Don’t settle for a brief or vague phone call from your insurer.
A denial letter will force your insurance company to “lock in” their rationale for rejecting your claim. It should also identify how to appeal their decision, and how much time you have to take legal action.
This document can serve as vital evidence should you decide to challenge the denial later on with help from my team.
READ MORE: Denied long-term disability? 4 reasons to get your insurer’s decision in writing
3. Appeals rarely work
Many claimants believe that an internal appeal with their insurance company will solve their issues.
After assisting thousands of clients with their LTD claims, the reality is that appeals rarely succeed.
The appeal process is controlled by the insurance company itself, which makes it an uphill battle for the claimant.
Insurers often use the appeals process to wear down your resolve, and chip away at the amount of time you have left to do something about the denial.
In my experience, the goal for insurance companies is to avoid paying out legitimate LTD claims to maximize their profit for shareholders.
While it may sound discouraging, remember that this is not your only recourse. If the internal appeal doesn’t work out, there are other steps you can take.
READ MORE: 3 reasons you shouldn’t appeal a denied long-term disability claim
4. A disability lawyer is your best ally
You don’t have to go through this on your own. If you have been denied or cut off from LTD benefits in or around the GTA, contacting a compassionate Toronto disability lawyer at my firm should be your immediate next step.
Navigating the maze of disability claims, especially after a denial, can be daunting. This is where our expertise at Samfiru Tumarkin LLP comes into play.
By making your insurance company talk directly to us about your LTD claim, we lift the burden off of your shoulders.
Utilizing our unique knowledge and experience, we will ease your stress, ensure that your rights are upheld and greatly improve your chances of obtaining the benefits you deserve.
READ MORE: What to expect when hiring a lawyer to fight your disability claim denial
5. You have a two-year window to take legal action
In Toronto, and across Ontario, there’s a limited amount of time that you can challenge a denied LTD claim. You have two years from the date of the denial to initiate legal action and seek compensation.
While this might seem like ample time, it’s crucial that you act promptly.
Legal processes can be time-consuming, and gathering the necessary documentation and evidence requires diligence. The sooner you begin, the greater your chances of building a strong case.
A quick and easy way to find out if the compassionate team at Samfiru Tumarkin LLP can help you is by using our Pocket Disability Lawyer.
We regularly resolve issues in Toronto (and across Canada) involving LTD, short-term disability, life insurance, critical illness and mortgage insurance claims.
My firm offers consultations at no cost to you, and we don’t get paid unless you get results. Over the years, we have helped thousands of clients, including Sandra Bullock and Julie Austin, secure the compensation that they are legally entitled to.
Has your LTD claim been denied in Toronto or the GTA? Not sure where you should turn for help?
Contact the firm or call 1-855-821-5900 for a free consultation with a disability lawyer. We help Canadians across all provinces (excluding Quebec). Get the advice you need and the compensation you deserve.
Sivan Tumarkin is a disability lawyer and co-founding partner at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in long-term disability claims and employment law. He provides legal insight on Canada’s only Disability Law Show on TV and radio.