My LTD Insurer is Treating Me Unfairly. What Should I Do?

An insurer can challenge your long-term disability (LTD) claim, from claiming you haven’t provided sufficient medical documentation to refusing your claim outright. And if the company’s adjuster on your file is rude and unhelpful, it can just make the process that much more frustrating and overwhelming.

If you believe your insurer is acting unfairly, it is important to take action to protect your rights and seek a fair resolution to your situation.

Steps to address the issue can include these key considerations:

  • Understand your policy
  • Document everything
  • Record all conversations with your adjuster in writing
  • File a complaint
  • Seek legal advice
  • Contact a regulatory body
  • Consider alternative dispute resolution
  • File a lawsuit

Understand your policy

Begin by carefully reviewing your policy. Understand your coverage, rights, and obligations. Pay attention to provisions that may be relevant to your situation, including claim procedures, timelines, and dispute resolution procedures.

Keep a detailed record of all communication with your insurer, including dates, times, names of the representatives you speak to, and summaries of the conversations. Document any written communication, such as emails or letters. These records can be crucial in establishing a timeline and proving your case if it ends up escalating further.

Let your adjuster know in writing if you think their conduct is unacceptable and ensure that all future conversations are in writing so you’ll have a written record of everything that transpired.

If you have not been able to resolve the issue through direct communication with your insurer, consider filing a formal complaint. Submit a written complaint outlining the details of your situation and your reasons for believing you are being treated unfairly. Attach any relevant documentation that supports your case.

If your insurer continues to treat you unfairly or fails to address your concerns in a satisfactory way, consult with an insurance law lawyer who can assess your case, provide advice about your legal rights, and guide you through the next steps.

Report your concerns

You can report your concerns to Ontario’s Financial Services Regulatory Authority of Ontario (FSRA) for assistance in resolving the issue. This regulatory body oversees insurance companies and handles consumer complaints.

Alternative dispute resolution, such as mediation or arbitration, is a consideration if the complaint process does not bring about a satisfactory outcome. These methods can help bring about a resolution without going to court and can be less expensive and time-consuming.

As a last resort, you can file a lawsuit against your insurance company. Consult with a lawyer, who can assess the strength of your case and guide you through the legal process.

Each case is unique and the steps you take depend on its specific circumstances. Gather as much information as possible and maintain clear and professional communication throughout the process. If you believe that your insurer has treated you unfairly, consider seeking legal advice to examine your rights.