There is no shortage of ways that insurance companies will attempt to deny legitimate long-term disability (LTD) claims. Even though the denial creates stress and sleepless nights for claimants in need, the focus for insurers, in my experience, is on increasing their bottom line.
A reason I frequently receive from my clients is that their LTD claim was turned down because the insurance company’s medical consultant doesn’t think they are disabled.
READ MORE: 4 reasons long-term disability claims are rejected, and how to fight back
If you find yourself in this situation, here are the top three things you need to do.
1. Determine if the medical consultant is qualified to comment on your case
The medical consultants hired by insurers, in my experience, often lack the correct expertise to determine if you should qualify for disability benefits.
Typically, they are general practitioners or family doctors. While it’s not inappropriate for these medical professionals to provide a report, your situation might require a specialist.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
In some cases, the medical consultant will acknowledge this in their report and recommend that a specialist also review your case. However, insurers often don’t follow that advice.
This happened to one of my clients who suffered a bad concussion. She had chronic pain, headaches, and psycho-cognitive issues.
The report provided by the insurance company’s medical consultant gave opinions on her pain and headaches, but recommended that she see a neurologist about her cognitive difficulties.
Instead of doing this, the insurer hastily denied her disability claim. Samfiru Tumarkin LLP took legal action against the insurance company and we were able to resolve her claim for a very favourable amount of compensation.
READ MORE: What to expect when hiring a lawyer to fight your disability claim denial
2. If the medical consultant did a paper-review, seek legal counsel
It’s not uncommon for the medical consultant hired by the insurance company to write their report on your case without speaking to you.
Instead of asking you to participate in an in-person or virtual assessment, many choose to rely exclusively on the information included in your medical file. This is called a paper-review.
Medical consultants often don’t do a comprehensive review of your file. They only look at certain aspects before providing their conclusions.
READ MORE: The insurer cut off his benefits. Then his lawyer reviewed his medical assessment
If your LTD claim is denied after the insurer’s medical consultant did a paper-review, contact an experienced disability lawyer, like the ones at Samfiru Tumarkin LLP.
We can review your situation, inform you of your legal options and help ensure that you receive the compensation you are owed.
3. Skip the appeals process if your LTD claim is denied
After your insurer has turned down your LTD claim, you will likely receive an invitation to appeal the decision.
The appeals process is usually handled by the same insurance company that initially denied your disability benefits.
Appeals rarely work. By appealing multiple times, you run the risk of running out the clock on your two-year window to take legal action against the insurer.
READ MORE: 3 reasons you shouldn’t appeal a denied long-term disability claim
Once the two years are up, the insurance company doesn’t have to pay your LTD claim and you can’t file a legal claim to get the money you deserve.
Let a disability lawyer fight for you
If your long-term disability claim is turned down, don’t lose hope. It’s important to understand that you may still have options.
The team at Samfiru Tumarkin LLP regularly resolves LTD claim denials in Ontario, Alberta and British Columbia.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
Our firm knows the law and we have successfully helped numerous clients, including Sandra Bullock and Julie Austin, hold insurers accountable after their claims were denied or closed prematurely.
We provide free consultations and don’t get paid unless we secure the compensation that you are legally entitled to.
Long-term disability claim denied? Asked if you want to appeal the insurance company’s decision?
Contact the firm or call 1-855-821-5900 to secure assistance from a disability lawyer in Ontario, British Columbia or Alberta. Get the advice you need — and the compensation you deserve.
Michael Gerhard is a disability lawyer and senior associate at Samfiru Tumarkin LLP, one of Canada’s leading law firms specializing in employment law and disability claims. The firm provides free advice through Canada’s only Disability Law Show on TV and radio.