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The chances of getting approved for long-term disability benefits through the internal appeals process are slim. Internal appeals involve employees of the insurance company reevaluating their file and seeing if they agree with the decision they just made. While there are some cases when this may be successful, they are limited.
We sometimes recommend that clients skip the internal appeal and pursue a lawsuit instead. This tactic may be possible if we can prove you qualify for disability benefits based on your long-term disability policy.
Unless there is a reason to believe otherwise, we often consider an internal appeal a waste of time. There are strict deadlines on challenging denials externally, so we do not want to spend more time fighting the internal appeals process unless we believe it may be beneficial based on the facts of your case. If you have already provided the insurance company with everything you have, how can the outcome be any different? It can’t.
An Internal Appeal Is a Strategic Option Only in Some Cases
Many people believe the next step after you receive a denial is to file an internal appeal, which may not always be the most strategic option. In fact, we generally only recommend it if we believe a quick internal appeal letter and additional evidence could reverse the decision. For example, this might be a good idea if your insurance company based your denial on a technicality such as:
- A missed doctor’s appointment
- A skipped treatment
- A medical clarification is needed
In these instances, a quick resolution of the technicality may make the internal appeal process worthwhile.
You may also have new medical information, such as test results, medical imaging, or documentation from a new doctor, that you are considering submitting as part of the appeals process. A disability lawyer may be able to review your case and help you determine if your new evidence would be more effective in an internal or an external appeal.
Additional Options for Fighting a Long-Term Disability Denial
Overturning a denial is not as simple as submitting a missing file. You may be able to take external action to pursue compensation based on the facts of your case, though.
If we believe you qualify for long-term disability benefits, we may be able to secure evidence to support your claim and take legal action on your behalf. This action could include:
- Suing the insurance carrier for compensation based on the wrongful denial of your claim
- Negotiating an out-of-court settlement with the insurance carrier to compensate you
- Taking your case to court and presenting evidence to show the insurer wrongly denied your claim
It is important that we get to work on fighting your denial as soon as possible; there is a two-year deadline set by the Limitations Act. In some instances, that deadline is just one year. Filing an internal appeal does not change this deadline. The clock starts running on the date of your initial denial. If we do not sue the insurance carrier before the deadline arrives, you may not be able to later.
Navigating the Process to Challenge Your Disability Denial
If you trust us with the facts of your case, our lawyers may be able to determine a route to challenge your benefits denial. In a typical disability appeal case, our lawyers may be able to help you:
- Understand the precise reason for the denial of your claim
- Review your initial claim for any missing information
- Gather evidence that was missing from the original claim, or produce new evidence with additional testing or second opinions if possible
- Hire medical or vocational experts to review your case and make a statement in your defense
Once we examine your case and assemble all evidence, we may be able to recommend whether to file an internal appeal or an external appeal in your case. If we prove you meet the qualifications outlined in your policy, our lawyers may bring your case to court. Alternatively, we may be able to reach an out-of-court settlement on your behalf.
Talk to a Toronto Long-Term Disability Legal Team About Your Denial
If your insurance carrier denied your claim for long-term disability benefits and you believe you meet the qualifications as defined by your policy, our team wants to talk to you about your denial. A member of the personal injury team from Preszler Injury Lawyers may be able to represent you during an appeal or lawsuit.
Our firm works on a contingency-fee-basis, meaning you do not need to pay upfront for our services. Our payment is a percentage of the settlement you receive.
Our lawyers serve Toronto and all other areas in Ontario. To learn more about how we may be able to help, call Preszler Injury Lawyers today at 1-800-JUSTICE. Initial consultations are free, and our staff is available to answer phones 24 hours a day, 7 days a week.
