Internal vs External LTD Appeals

Over the last few weeks we’ve been talking about the common reasons that applications for LTD benefits are denied or cut off.  If this has happened to you, you likely feel frustrated, exhausted and scared about the future. You’re not alone. Like CPP Disability, a huge number of applications for LTD are rejected, but that doesn’t mean you can’t win.

Today we’re going to talk about appealing the decision of an LTD insurer to reject your application or cut off your benefits.

Right away, it’s important to emphasize that insurance companies build a certain amount of hassle into their processes in order to discourage people from pursuing a claim. The reality is that it is in their interest to pay out as little in benefits as possible. This is the nature of their business model even though people pay their insurance premiums with the expectation that if they need benefits.  They will be received.

To appeal the decision of the insurer, you have two paths: internal appeals and external appeals.

Internal Appeals

An internal appeal involves asking the insurer to reconsider their decision. No outside parties like judges or arbitrators are involved. There are circumstances where it may be worth your time to pursue an internal appeal, such as:

• requirements stated in the denial letter, like undergoing more testing or providing more information
• a technicality that can be easily resolved, like lost/missing documentation or an error you made in your application, or a missed appointment or treatment
• new and persuasive medical evidence that’s been established since your original application

The internal appeal system is very difficult to win because it’s set up as a deterrent. You can spend a lot of time and energy on one or more rounds of internal appeals and come away with nothing. That is why we generally don’t encourage clients to pursue an internal appeal.

External Appeals (aka Lawsuits/Litigation)

We believe that in the face of denied claims or cut off benefits, it is much more efficient to simply begin a lawsuit against the insurer. There are a couple reasons for this:

• courts are more likely than insurers to agree that your disability is permanent
• there are limitation periods in which you must begin your legal action (one or two years, depending on your policy). If you spend a lot of time on internal appeals, you could miss the deadline to begin litigation.
• we take on the tasks and effort of moving your claim forward, relieving that stress from your shoulders and allowing you to focus on your health

In our experience, insurance companies never really accept that a person is disabled from all employment, but they will respond to litigation–the goal of which is a settlement or a court decision in your favour.

Sometimes when people have had their application rejected or their benefits cut off, they go back to work because they need to earn a living. Unfortunately, in these circumstances, people often become sicker or injure themselves further. If this sounds familiar, please contact us today so that we can help.