A long-term disability appeal can be a scary thing to come up against. So, it’s important to know what you’re getting into. In this article, I will share some important facts about long-term disability appeals that you need to know before you are in too deep.
- There is always context to your claim
- There are 2 types of long-term disability appeals
- Long-term disability appeals have deadlines
- The first 2 years of your claim is a very important period
- Don’t skip internal LTD appeals
- Proper documentation can make or break your long-term disability appeal
- Your actions are important, so act with the end in mind
- You have to work with the insurance company
- It’s hard to look at your own situation objectively
This is part of our Long-Term Disability guide.
There is always context to your claim
You have to understand where you are in the big picture of your claim. If you’re early in the process, then you’ll have a better chance of success. If the insurance company doesn’t have much information, or if they haven’t spent much money, then you’re more likely to see your denial overturned.
On the other hand, if you’re further on in the process, then they likely have more information. They will have found people to give bad opinions about you and spent a lot of money on doctors and specialists. Time and money spent gives the insurance company an incentive to deny your benefits.
There are 2 types of long-term disability appeals
Basically, the process in Canada is always the same, no matter the insurance company or policy.
You send in an application. If it gets denied, then you get 1-3 internal appeals. If you don’t get approved at that level, then you will have an external appeal (or “legal appeal”) for a final decision.
Usually, you can handle the first internal appeal on your own without a lawyer. There are a couple of things you need to keep in mind, however.
What does the decision-maker believe and expect? What will you need to be successful? This article can help answer those questions:
If you’ve tried and lost one internal appeal on your own, it’s advisable to seek some legal help.
External / legal appeal
Once you’ve done your internal appeals, you will move on to an external appeal. We call these legal appeals or lawsuits. In other words, this is the final decision with a 3rd party decision-maker. Usually, this will be a judge or arbitrator that doesn’t work for the insurance company.
Long-term disability appeals have deadlines
Sometimes the deadlines can be loose or suggested. But, some are very strict. You’ll need to know your deadline. Find out if it can be extended, or if it’s hard and fast. Most can be extended. But, if they’re strict, you need to know that and act within the timeframe.
The first 2 years of your claim is a very important period
The first two-year period is the best chance for the insurance company to cut off your benefits. This is when your policy’s definition of disability changes from being unable to do your “own occupation” to being unable to work “any occupation.”
If they approve you beyond the change of definition, then it’s harder to cut you off in the future. It’s easier to get a long-term disability appeal approved at the beginning of 2 years. It’s much harder near two years, or after.
Don’t skip internal LTD appeals
Some lawyers will tell you that you can’t win an internal appeal and that they’re a waste of time. They suggest that that you should lawyer up and sue the insurance company right away. This isn’t always correct.
Consider doing an internal appeal. But, you should also consider hiring a lawyer. The insurance companies know that lawyers will push for a lawsuit. If you have a lawyer early on, they’re more likely to approve you right away. We have had success representing people in internal appeals.
Proper documentation can make or break your long-term disability appeal
A huge part of succeeding in your appeal is your medical documents. Properly documenting your treatment plan and limitations can make or break your case. If you didn’t submit the proper records, your appeal is your next chance to do that.
Your actions are important, so act with the end in mind
You might only be doing your first long-term disability appeal, but you have to consider how far it could go. If this is going to go to a judge, then you want the judge to see that you’ve been reasonable, taking the high road, and cooperating. It’s so important that you maintain your credibility throughout the process. Even if it seems like the insurance company is messing with you, figure out a way to make things work. If you come up in front of a judge, this will look great for you. You have to be conscious of your credibility the whole way.
To read more about this, you can check out our Story Alignment Method. This is crucial to how we help our clients win the benefits they deserve.
You have to work with the insurance company
Look to cooperate as much as possible instead of arguing or withholding information. The insurance company has to understand your situation, and you should be trying to build a good relationship.
It’s hard to look at your own situation objectively
Probably the biggest challenge with long-term disability appeals is that people are unable to objectively look at their situation. The insurance company will have expectations and beliefs about your claim. It’s extremely difficult for someone to look at their own situation and see these. That’s why getting a lawyer or another set of eyes on your case is so helpful.
Learn the secrets for winning long-term disability benefits
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