If you have been denied disability in Ontario, it is important to understand that you still have options. Many denials are based on simple misunderstandings that could be quickly cleared up. Other cases might not be so simple, but that does not limit your chances of recovering benefits under a short- or long-term disability policy.
Denials are common. After all, insurance companies will always put their bottom line above everything else. In some cases, this could mean the unfair denial of benefits. It is important not to be discouraged. Not only are denials common, but so are appeals. The success of your case will depend on the potential strengths and weaknesses of the claim.
Potential Strengths and Weaknesses
No two disability claims are exactly alike. They each have strengths and weaknesses that increase or decrease your chance of a successful claim. One of the most important strengths of a disability claim is possessing proper documentation. By having all of the documents necessary to process the claim, you could protect yourself against unfair denials. Another important benefit is having demonstrable injuries. Some conditions are undetectable, which can make a claim challenging.
One of the biggest disadvantages involves missing filing deadlines. If you filed your claim after the deadline, the insurance company could have a powerful excuse to deny it. Additional weaknesses could include missing documentation or inconsistent statements made to the insurance company.
To fully appreciate how these strengths and weaknesses impact your claim, it is helpful to understand the appeals process in general.
The Denial Process
It is the responsibility of your insurance provider to inform you of your denied disability claim. This notification comes in the form of the denial letter, which the insurance company will send to you and your employer separately.
This document is important. The letter will provide you with basic information on the reason your claim is denied. Typically, it will cite the section of your insurance policy that requires the denial. The letter will also come with an effective date. This date is crucial, as it starts the clock running on your right to appeal.
There are two types of appeals when it comes to denied benefits. These include internal and external appeals. An internal appeal involves asking the insurance company to take a second look at a denied claim. An external appeal typically involves filing a lawsuit and putting the denial in the hands of the courts.
Internal Appeals
An internal appeal is little more than asking the insurance company to re-consider your denied claim. It should not come as a surprise, then, that these appeals often result in the same outcome as the original decision. That does not mean they are never worthwhile. Some denials are specifically based on a lacking document or a request for additional information. In some cases, providing that information through an internal appeal could result in the reversal of a denied claim.
This can be helpful if you were still in the process of compiling medical documents as the deadline to appeal approached. Filing an incomplete claim protects your rights and could allow you to provide the information later during an internal appeal.
External Appeals
For many, taking the decision out of the hands of the insurance company entirely is in their best interest. This involves filing a legal claim against the insurance company based on their failure to uphold their end of the contract.
Once your case is in the legal system, you have important rights that were not guaranteed to you during the internal process. While taking legal action against an insurance company might seem intimidating, successful appeals are common. In the end, an external appeal could provide you with the best chance for a positive outcome in your denied disability.
Denied Disability? Here’s What to Do
If you were denied disability in Ontario, It is important that you take immediate action. While you have the right to fight this denial, any delay could result in you being denied for disability permanently.
First and foremost, keep every piece of communication you receive from the insurance company. The denial letter and any additional letters could have important information you will need to pursue your claim.
Next, take steps to compile the documentation related to your denial. This could include anything from your medical records to any written notices sent to your employer.
Finally, you could benefit from the advice of a lawyer. Whether it is guiding you through the internal appeal process or filing a lawsuit, a lawyer could assist you with the technical requirements that you might not be aware of.
