Confused? Disability Claim Internal Appeal Explained

Disability Claim Internal Appeal Explained

Unfortunately, it is commonplace for insurance companies to deny short-term and long-term disability claims. These denials happen for a variety of reasons, although that reason is not always clear.

Upon a denial, you have the right to appeal the insurance company’s decision internally instead of immediately filing a lawsuit.

Keep in mind, though, that there is a time limit to file a suit. If you miss that deadline, you lose your chance at recovering the compensation you need.

To appeal a decision, your first step is to request an internal review.

The purpose of a review is to ensure every rule of the Ontario Disability Support Program was followed. Once the internal review is completed, the company will uphold the rejection, reverse the decision, or give you 90 days to supply additional documents.

If you are unhappy with the outcome of the internal review, the next step is to appeal to the Social Benefits Tribunal.

You are not guaranteed the right to appeal to the Social Benefits Tribunal. In fact, when you receive your decision from the Internal Review, that letter will inform you if you are eligible to appeal to the Social Benefits Tribunal or not.

If you do have the right to appeal, there are two times when that appeal is allowed:

• When you disagree with the outcome of the Internal Review, or
• When your request for an Internal Review goes unanswered for more than 30 days.

If the Social Benefits Tribunal agrees with you, your chance of resolving your claim remains active. However, a denial at this stage brings your appeal to a close.

Thankfully, that does not mean you cannot still seek compensation for your damages through a lawsuit.

Pros and Cons of Pursuing a Disability Claim Internal Appeal in Ontario

Now that you have had the process of a disability claim internal appeal explained, you have a choice to make. If your claim has been denied, you must decide to either pursue an appeal or file a lawsuit.

There are some situations where an appeal is worthwhile. Specifically, if the initial review was made before you had a clear view of your medical needs, an appeal might be successful if you have more documentation to share. This is especially true if you have undergone a procedure since the date you applied.

If you opt to file an internal appeal, you should go into it with the understanding that there is an inherent bias in the process. The insurance company adjuster is responsible for the review, meaning these appeals are typically biased towards the insurance company. Another complication involves the risk of delay. You are limited to the time frame to file suit.

In Need of Help

An experienced disability lawyer can review your case, give explanations and advice on your options. If you need to proceed with a lawsuit, they will lead you through the entire process to ensure your get everything you deserve. They is no need to suffer alone.