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What to do if you are denied long term disability?

You received a long term disability denial letter 

If you have received a letter of denial from a long term disability insurer you should contact a personal injury and disability lawyer as soon as possible if you have not already retained one. 

There are deadlines attached to responding to such letters and usually an internal process of review and appeal which you can request your insurer to begin. 

Upon receiving a denial letter you should send a copy to your lawyer and read it through carefully.  Such letters, in addition to spelling out your rights of appeal and how to initiate the appeal process, usually contain detailed analysis of your claim, the test for disability and the reasoning behind the insurance company’s denial.  These letters often cite specific examples from your medical records and list sections of the insurance policy to explain why the insurer is denying you. 

It is important that you review the letter so you understand the insurer’s position.  This will tell you why you are being denied and give you a road map for fighting back and convincing the insurer why they are wrong and you do qualify for the benefit.  

Sometimes the letters are requesting additional information to support your claim or specific x-ray, scans or test.   If so these requests should be complied with, if reasonable, as they may cause the insurer to reconsider. A disability insurance lawyer will help you understand why you are being denied and what can be done to satisfy the insurer that their decision is wrong and you should receive your benefit. 

Running out of benefit funding

A disability insurance lawyer can help you explore what other avenues you may have to financially assist you while you appeal your disability benefit denial.  Other federal province or private disability benefit funds may be available that can breach the gap of financial need while you wait for either an appeals process or litigation.  

Sometimes litigation loans are available which can be applied for. 

Sometimes part time/ alternative employment can be pursued to assist with the financial need.  This all needs to be discussed thoroughly with a disability lawyer as receipt of any additional disability insurance benefits and/or part time or casual employment income will affect your disability benefit amount or qualification for the benefit entirely.  However a disability insurance lawyer can walk you through the pros and cons for each of these potential solutions to see if there is a fit for your situation. 

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How can a disability lawyer help?

A disability lawyer will help explain to you your rights under your specific disability insurance policy, the reasons for the insurer’s denial, and assist with both financial support and the appeals or litigation process so you can fight back against an insurer’s denial.

A disability lawyer will first off get a copy of and review your policy so you have a proper understanding of the test that you must meet.  Every disability insurance policy is unique.   It is an insurance product you or your employer purchases for you and your rights under that product are only as good as they are set out under the policy and as interpreted by case law and statute.  

The tests for qualifying for disability vary from policy to policy however.  Some disability insurance policies are easier to qualify under then others.  Some have longer coverage periods and pay more generous benefits with less offset provisions.  Others are more difficult to qualify for and have extensive exclusion clauses.  The meaning of your specific policy can be reviewed by your disability insurance lawyer and explained to you so you know the test you must meet and how to gather evidence that you do in fact qualify. 

Next a disability lawyer will assess your specific medical situation, the medical professionals your seen, the treatments you’ve had in the past and in the future and formulate a plan for how to compile the right sorts of evidence that will convince an insurer that you meet their test for disability.  This may require the arranging of additional medical assessments and if so your disability insurance lawyer will make those arrangements for you and forward the results onto the insurance company. 

Finally if the insurer remains unconvinced your disability insurance lawyer will make sure your claim is filed with the appropriate level of court and conduct the steps of litigation for you including document and oral examinations for discovery and eventually mediation and or trial. 

What happens at the end of a long term disability lawsuit?

Like all civil litigation a long term disability legal action has many steps.  The filing and serving of a written statement of claim that outlines the basics of the actions begins the case.  Documents are exchanged and oral examinations for discovery are scheduled for counsel to cross examine the parties under oath.  At any step along the way a case can be settled out of court.  It is common for the parties to a disability insurance claim to schedule a private mediation prior to the trial or even the examinations for discovery to explore financial settlement with the help of a mediator.  Often these mediations are successful in resolving the case long before a case needs to go to trial.  Your disability insurance lawyer will build your case for you and explore settlement at several stages along the way as it makes the most sense for the strategy of your case. 

Taking Action

If you feel you have a valid long or short term disability claim and you have questions or need assistance at any stage remember to contact the Disability Lawyers at FDT Law  at 1-800-563-6348 to get a consultation. 

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