Should You Avoid Disability Claim Internal Appeals with Your Insurance Company?
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      Disability

      Should You Avoid Disability Claim Internal Appeals with Your Insurance Company?

      Should You Avoid Disability Claim Internal Appeals with Your Insurance Company?

      After working with an organization for several years, you would hope that if you succumbed to a disability, your employer and insurance provider would be supportive in your time of need. For your employer, your disability benefits are an expense that they would prefer not to pay. Periodically, employers or insurance companies are not forthcoming with the paperwork needed to complete a long-term disability claim. This scenario only makes you want to avoid disability claim appeals. But, should you avoid disability claim internal appeals with your insurance company?

      The process of getting paperwork from third parties (your doctor, your employer, your insurance company) can be exceptionally time consuming and frustrating. Additionally, the company providing your LTD insurance may want you to sign a release that authorizes them to gather your medical information, which will take more time.

      After you spend a significant amount of effort gathering the information to submit your claim, you can still be denied by your LTD insurance provider. This is where dispute resolution is valuable. If your insurance provider has denied your disability claim, strongly consider filing an appeal with them, but use caution.

      Background Regarding Internal Appeals and Litigation

      A qualified disability lawyer will be able to determine if an internal appeal makes sense for you. In some situations, it does not. If you have an application for long-term disability benefits that was denied or if your insurance provider made the decision to stop your payments, there are fundamentally two options available to you.

      ● Using the internal process for appeal provided by your insurance company, you can petition the decision.
      ● You can file a lawsuit and appeal the decision in court.

      Neither option would be appealing to someone in perfect health, not to mention someone dealing with a chronic disability. One path leads to internal appeals. The other leads to litigation.

      An appeal means you are requesting the insurance company reevaluate its pronouncement. The process of the insurance provider’s reevaluation is called an internal appeal. Each insurance company has a different method of conducting theirs. However, similarities exist among them.

      Typically, the internal appeals process involves up to three different phases of reconsideration. It also includes acquiring more of your medical information for the insurance provider. Also, their doctors may want to conduct their own assessments. The entirety of the process can take several months.

      When it is Sensible to File for an Internal Appeal

      If there is a chance the insurance provider will approve the appeal, then it makes sense to go through the arduous process. You may be victorious after an internal appeal if:

      ● The insurance company asks for clarification from your doctor after initially denying your claim.
      ● You did not provide all the information the insurance company asked for.
      ● You did not attend an appointment or go through with certain medical treatment at the time your claim was denied but have since done so.
      ● You doctor provided insufficient information to the insurance company.

      The internal appeal process makes sense in some cases but not all. If you are in the initial stages of the claims process and your claim was denied for a legitimate reason and you have the medical records or information to address the oversight, an internal appeal is a good idea. Otherwise, it is not recommended. If you decide to fight, you will need a great disability lawyer in Toronto who is versed in battles of this nature.

      Disclaimer: The content of this article is a general guideline made available for educational purposes only and is not intended to be used as legal advice for the reader's specific situation nor in general. By reading our blog and website content, the reader acknowledges the above and understands there is no lawyer-client relationship created between you and Himelfarb Proszanski through this content. To get specific legal advice, we encourage you to book a free consultation with one of our lawyers to clarify the legal aspects of your situation.