When a person is unable to work due to a serious illness or injury, long-term disability (LTD) benefits are often their only financial safety net. Unfortunately, these claims are frequently denied. That’s why it’s important to speak with a long-term disability lawyer in Vancouver as soon as possible after a denial. A lawyer can guide you through the complex appeal process and help build a stronger case for approval.
Why Claims Get Denied
Insurers reject LTD claims for many reasons, some more technical than others. Common causes include insufficient medical documentation, missed deadlines, or an assessment that the claimant doesn’t meet the policy’s definition of “total disability.” In other cases, surveillance, social media activity, or inconsistent doctor notes can trigger skepticism.
When a denial letter arrives, it typically outlines the insurer’s reasoning and the next steps. This document is critical. It sets the stage for how your appeal will be framed, what evidence you’ll need, and how much time you have to act.
Time Is Limited
Most LTD policies have strict deadlines for filing an appeal. This window is often between 60 and 180 days, and missing it can permanently close the door on your claim. It’s essential to act quickly and use the available time to gather new information and improve your submission.
Some plans require an internal appeal, meaning the insurer re-evaluates your claim with additional documentation. Other plans may allow or require you to proceed directly to legal action. Understanding the structure of your specific plan is key to choosing the right path forward.
Gathering the Right Evidence
Successful appeals often hinge on the strength of the evidence provided. This can include updated medical records, letters from physicians, results of new diagnostic tests, or independent medical evaluations. Your goal is to show clearly that your condition prevents you from working, either in your current occupation or in any occupation, depending on your policy language.
Personal statements can also make a difference. Describing how your condition limits your day-to-day functioning adds context that raw medical data may miss. Supporting letters from family, coworkers, or employers can reinforce your credibility and give your appeal a human touch.
Understanding Independent Medical Exams
If your insurer requests an independent medical examination (IME), take it seriously. These exams are conducted by doctors hired by the insurance company, and their reports often carry significant weight. Prepare by reviewing your medical history, bringing a list of your symptoms, and being honest but clear about your limitations. A lawyer may also help you anticipate questions and understand your rights during the process. Responding appropriately can be crucial to the outcome of your appeal.
When Appeals Fail
If the internal appeal is denied, you may need to escalate your case through litigation. This process involves filing a legal claim against the insurer. While it can take longer, many cases settle before going to court. A lawyer can handle negotiations, filings, and communications to help you stay focused on your health.
Litigation brings stricter rules around evidence and deadlines, so professional representation is even more important at this stage. Legal expertise levels the playing field when you’re up against an insurance company’s legal team.
Conclusion
Receiving a denial doesn’t mean your claim is invalid. It just means more work is required. Many individuals who persist ultimately receive the benefits they’re entitled to. A well-prepared appeal, supported by strong documentation and legal guidance, can shift the outcome in your favor.
